Abstract
The minimum acceptable oxygen delivery and flow rates during neonatal ECMO remain to be defined. We have studied the relationship of perfusion flow rates and hemoglobin saturations to oxygen delivery (DO2), oxygen consumption (VO2), systemic oxygen pH, lactate, and bicarbonate concentration in neonatal baboons. The right internal jugular vein, right carotid artery, both femoral arteries were cannulated, and the ductus arteriosus, aorta, and pulmonary artery ligated. The paralyzed animal was intubated and endotracheal tube clamped. We measured Hb, pH, PaO2, and PvO2 (from the circuit), high internal jugular PvO2, and pump flow; we calculated bicarbonates, saturations, DO2, VO2, SXO2, and CXO2. Six baboons were studied during each of two phases of the experiment. First, flow rates were varied from 200 to 50 ml/min/kg (30 min at each flow) with saturation maximized. Second, flow was maintained at 200 and saturation was serially reduced from 100% to 38%(30 min at each saturation) Results (x±SD, ml/min/kg): VO2 fell significantly below baseline at a flow rate of 50 and a DO2 of 8±2 in phase 1 and at a DO2 of 12±5 in phase 2. CXO2 fell significantly at DO2 of 16±6. Flows of 50 ml/min/kg may provide adequate O2 delivery for short periods of time, but flows <100 and DO2 <17 may be inadequate over longer periods. O2 extraction is reduced even at max. flows when Hb saturation is decreased.
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Cornish, J., Gerst-Mann, D., Null, D. et al. RELATIONSHIP OF PUMP FLOW RATE AND HEMOGLOBIN SATURATION TO INDICATORS OF SUFFICIENCY OF OXYGENATION DURING EXTRACORPOREAL MEMBRANE OXYCENATION (ECMO) IN THE NEWBORN BABOON. Pediatr Res 21 (Suppl 4), 199 (1987). https://doi.org/10.1203/00006450-198704010-00196
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DOI: https://doi.org/10.1203/00006450-198704010-00196