Prognosis Value of Early Veno Arterial PCO2 Difference in Patients Under Peripheral Veno Arterial Extracorporeal Membrane Oxygenation

Introduction: Veno arterial membrane oxygenation (VA ECMO) is increasingly used for cardiogenic failure. However, hemodynamic targets for adequate resuscitation remain a challenge. The PCO2 gap and the ratio between PCO2 gap and the arteriovenous difference in oxygen (PCO2 gap/Da–vO2) are marker of peripheral hypoperfusion. We hypothesized that the PCO2 gap and the PCO2 gap/Da–vO2 ratio might be useful parameters in VA ECMO patients. Patients and Methods: We conducted an observational prospective study between September 2015 and February 2017. All consecutive patients>18 years of age who had been treated with peripheral VA ECMO for cardiac failure were included. We compared two groups of patients: patients who died of any cause under VA ECMO or in the 72 h following VA ECMO weaning (early death group)—and patients who survived VA ECMO weaning more than 72 h (surviving group). Blood samples were drawn from arterial and venous VA ECMO cannulas at H0, H6, and H24. The ability of PCO2 gap and PCO2 gap/Da–vO2 to discriminate between early mortality and surviving was studied using receiver operating characteristic curves analysis. Results: We included 20 patients in surviving group and 29 in early death group. The PCO2 gap was higher in the early death group at H6 (7.4 mm Hg [5.7–10.1] vs. 5.9 mm Hg [3.8–9.2], P 
Source: Shock - Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research