The number of cases of veno-venous extracorporeal membrane oxygenation (VV ECMO) using the Avalon double-lumen catheter (Avalon-DLC) has been increasing. The catheter has many merits, such as less bleeding and reduced risk of infection. However, the diameters of the drainage and return lumens of the Avalon-DLC are smaller than those of cannulae for dual cannulation. Therefore, sufficient bypass flow may not be achieved, and blood oxygenation may be insufficient. The purpose of this study was to investigate whether VV ECMO using an Avalon-DLC can provide sufficient gas exchange performances.
An Avalon-DLC was inserted into eight adult goats (body weight 60.2±0.4 kg), and VV ECMO was performed. The arterial oxygen saturation (SaO2), arterial oxygen partial pressure (PaO2), and arterial partial pressure of carbon dioxide (PaCO2) were measured under only ECMO support without native respiration.
When the bypass flow rates were higher than 2L/min, the SaO2 was maintained at greater than 80%, and the PaCO2 was approximately within the normal range. At 20 minutes after the support, PaO2 was 23.7±1.2, 46.3±3.2, 91.9±9.7, and 159.6±29.8mmHg at 1, 2, 3, and 4L/min, respectively.
VV ECMO using the Avalon-DLC could obtain sufficient gas exchange.
Acute kidney injury associated with cardiopulmonary bypass (AKI-CPB) can occur because of cardiopulmonary complications. The renal toxicity of plasma-free hemoglobin (PF-Hb) is presented as one of the factors. Since January 2014, our hospital measured the PF-Hb in cardiopulmonary bypasses (CPB) and we introduced a method that administers haptoglobin (Hp) agents as an indicator of PF-Hb values. We selected 129 patients, having a body weight≤20kg, who received treatment at our hospital between January 2012 and December 2015, and they received CPB because of congenital heart disease. This comparative study includes 57 patients who were administered 25mL of the Hp drug when the blood concentration container held red waste or hemolytic urine (group A). The remaining 72 patients were administered 25mL of the Hp drug when PF-Hb values in the range of 0.03-0.05g/dL and 50mL when the PF-Hb value was≥0.05g/dL (group B). The study analyzed Hp drug-dose amounts, post-operative hemolytic urine occurrences, Acute Kidney Injury Network (AKIN) stage classifications, post-operative acute kidney injury (AKI) incidences, and liver function evaluations.
The dose of the Hp drug for group B was higher than it was for group A. However, the hemolytic urine occurrences, AKIN stage classifications, and AKI incidences were significantly decreased for group B. Moreover, significant differences were not observed in the number of hepatic injuries that were associated with administering Hp products.
In this study, we introduced a method of administering the Hp drug using PF-Hb measured in CPB as an index. As a result, although the amount of the Hp drug administered increased compared with the conventional method, it was possible to protect renal function without hepatic injuries.