Impact of draining cannula position and configuration under high-flow extracorporeal CO2 removal (ECCO2R) on recirculation and extracorporeal decarboxylation

Position du problème et objectif(s) de l’étude

The main goal of the present study was to demonstrate the influence of draining cannulas’ position and high-flow extracorporeal CO2 removal (ECCO2R) configuration on recirculation and extracorporeal decarboxylation.

Matériel et méthodes

This single-center retrospective study was conducted between January 2018 and May 2024. All patients who received a high-flow ECCO2R (extracorporeal blood flow ≥2L/min) were included. Four configurations each used an ECMO device, two single-lumen cannulas, and an ipsilateral cannulation site: CENTRAL DRAINAGE configurations (central jugular-jugular and central femoro-femoral), DISTAL DRAINAGE configurations (distal jugular-jugular and distal femoro-femoral) (Figure 1). Recirculation coefficient and CO2 elimination were assessed between these configurations. The influence of the configuration and recirculation coefficient on CO2 elimination was studied by multivariable mixed linear model.

Résultats & Discussion

Eighteen patients were treated with high-flow ECCO2R. Extracorporeal blood flows (median of 2.6 L/min [IQR, 2.0‒2.6L/min]) were comparable between the configurations (P=0.33), although values higher than 2.5 L/min were observed in CENTRAL DRAINAGE configurations. Median CO2 elimination was 110 mL(STPD)/min (IQR, 83‒149 mL(STPD)/min). Recirculation coefficient was significantly higher with the DISTAL DRAINAGE configurations (59% [IQR, 51‒71%] versus 9% [IQR, 15‒22%], respectively; P<0.001)(Figure 1). Consequently, CO2 elimination was significantly lower with the DISTAL DRAINAGE configurations (58 mL(STPD)/min [IQR, 44‒72 mL(STPD)/min] versus 122 mL(STPD)/min [IQR, 96‒159 mL(STPD)/min], respectively; P=0.003). Both DISTAL DRAINAGE configurations and high recirculation coefficient were significantly associated in multivariable analysis with a reduction in CO2 elimination (P<0.001).

Conclusion

We evaluated four different configurations of high-flow ECCO2R (Qec 2-3 l/min) using single-lumen cannulas allowing either a central or a distal drainage. A central drainage configuration gave better rheological conditions and lower recirculation, leading to better extracorporeal decarboxylation.

Auteurs

Clara MULLER, Mehdi GIRARD, Elie COURVALIN, Geoffrey DAGOD, Karim BOUCHDOUG, Pauline DERAS, Hugues WEBER, Xavier CAPDEVILA, Jonathan CHARBIT - (1)Chu Montpellier, Montpellier, France

Orateur(s)

Clara MULLER (Montpellier)