Which partial pressure of carbon dioxide during extracorporeal cardiopulmonary resuscitation (ECPR)?

Kevin P. Morris; Edgar Brincat; Irene Sanz; Barnaby R. Scholefield

doi:10.1016/j.resuscitation.2019.02.037

Which partial pressure of carbon dioxide during extracorporeal cardiopulmonary resuscitation (ECPR)?

Kevin P. Morris, Edgar Brincat, Irene Sanz, Barnaby R. Scholefield

Research output: Contribution to journal › Comment/debate › peer-review

Abstract

There is interest in the association between partial pressure of carbon dioxide (PCO ₂ ) and neurological outcome following cardiac arrest. Extracorporeal life support is increasingly used in the setting of refractory cardiac arrest (ECPR) but there is a lack of standardisation of PCO ₂ management during ECPR. We prospectively evaluated CO ₂ values and investigated the importance of blood sampling site in a series of 23 children undergoing ECPR, comparing the patient's arterial PCO ₂ (PaCO ₂ ) with samples taken pre- (Ppre-oxyCO ₂ ), and post- (Ppost-oxyCO ₂ ) the circuit oxygenator. Large reductions in PaCO ₂ were seen following initiation of ECPR; median reduction was 3.7 kPa, and 42% experienced a reduction >5 kPa in the first hour. The relationship between Ppre-oxyCO ₂ , Ppost-oxyCO ₂ and PaCO ₂ was not consistent or predictable, and the use of Ppre-oxyCO ₂ values to guide management was frequently associated with low PaCO ₂ values; 25% of patients experienced a PaCO ₂ below 3.5 kPa. PCO ₂ management during ECPR should be based on PaCO ₂ measurements and caution is needed to avoid rapid reductions in PaCO _2.

Original language	English
Pages (from-to)	42-43
Number of pages	2
Journal	Resuscitation
Volume	138
Early online date	8 Mar 2019
DOIs	https://doi.org/10.1016/j.resuscitation.2019.02.037
Publication status	Published - May 2019

ASJC Scopus subject areas

Emergency Medicine
Emergency
Cardiology and Cardiovascular Medicine

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10.1016/j.resuscitation.2019.02.037Licence: None: All rights reserved

Cite this

@article{d94af4b9ddd949dc8850f38d8196531b,

title = "Which partial pressure of carbon dioxide during extracorporeal cardiopulmonary resuscitation (ECPR)?",

abstract = "There is interest in the association between partial pressure of carbon dioxide (PCO 2 ) and neurological outcome following cardiac arrest. Extracorporeal life support is increasingly used in the setting of refractory cardiac arrest (ECPR) but there is a lack of standardisation of PCO 2 management during ECPR. We prospectively evaluated CO 2 values and investigated the importance of blood sampling site in a series of 23 children undergoing ECPR, comparing the patient's arterial PCO 2 (PaCO 2 ) with samples taken pre- (Ppre-oxyCO 2 ), and post- (Ppost-oxyCO 2 ) the circuit oxygenator. Large reductions in PaCO 2 were seen following initiation of ECPR; median reduction was 3.7 kPa, and 42% experienced a reduction >5 kPa in the first hour. The relationship between Ppre-oxyCO 2 , Ppost-oxyCO 2 and PaCO 2 was not consistent or predictable, and the use of Ppre-oxyCO 2 values to guide management was frequently associated with low PaCO 2 values; 25% of patients experienced a PaCO 2 below 3.5 kPa. PCO 2 management during ECPR should be based on PaCO 2 measurements and caution is needed to avoid rapid reductions in PaCO 2. ",

author = "Morris, {Kevin P.} and Edgar Brincat and Irene Sanz and Scholefield, {Barnaby R.}",

year = "2019",

month = may,

doi = "10.1016/j.resuscitation.2019.02.037",

language = "English",

volume = "138",

pages = "42--43",

journal = "Resuscitation",