Which partial pressure of carbon dioxide during extracorporeal cardiopulmonary resuscitation (ECPR)?
Research output: Contribution to journal › Comment/debate › peer-review
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.