Extracorporeal Membrane Oxygenation Support for Dogs in Acute Respiratory Failure : Comparison of venovenous extracorporeal lung assist using a double lumen tube with venoarterial extracorporeal lung assist / 대한마취과학회지

ABSTRACT

Mechanical ventilation is widely used for the respiratory support in patients with acute respiratory insufficiency. Extracorporeal respiratory support using a membrane oxygenator has been developed to relieve refractory hypoxemia or hypercapnea under conventional ventilatory management. It has been called extrcorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO2R) or extracorporeal lung assist (ECLA). Venoarterial (VA) ECLA drains blood from a catheter placed in the right atrium via the internal jugular vein and perfuses through a cannula at the level of the aortic arch via the right common carotid artery. While VA ECLA supports the heart as well as the lungs, but it has the disadvantage of requiring carotid artery ligation. In venovenous (VV) ECLA, perfusion cannula is placed at a large vein and the carotid artery is not ligated. In addition there is theoretical advantage of perfusing the well oxygenated blood to pulmonary artery. We hypothesized that VV ECLA is as effective as VA ECLA in the oxygenation of arterial blood when the respiratory insufficiency does not accompany heart failure. A model of acute respiratory failure was induced on 6 dogs by the injection of oleic acid 0.07 ml/ kg. Two hours later, acute hypoxemia and hypercapnea were identified with acute hemorrhagic pulmonary edema, but the hemodynamic parameters were stable for 2 hours. Oleic acid 0.07 ml/kg was injected on another 7 dogs. A double lumen tube and a perfusion cannula were introduced via the right external jugular vein and the carotid artery, respectively. The outer lumen of a double lumen tube was used for the drainge of both VV ECLA and VA ECLA. Mixed venous oxygen tension (PvO2) was higer in VV ECLA than in VA ECLA, but arterial oxygen tensian (PaO2) in VV ECLA was as high as that in VA ECLA. It could be concluded that VV ECLA using a double lumen tube can be used as an alternative to VA ECLA for the respiratory support of acute respiratory failure.