Quantitative Gas Exchange in Extracorporeal Membrane Oxygenation-A New Device: Accuracy, Approach-based Difficulties, and Caloric Targeting
Abstract
Measurement of oxygen uptake (VO2) and carbon dioxide removal (VCO2) on membrane lungs (MLs) during extracorporeal membrane oxygenation (ECMO) provides potential for improved and safer therapy. Real-time monitoring of ML function and degradation, calculating caloric needs as well as cardiac output, and weaning algorithms are among the future possibilities. Our study compared the continuous measurement of the standalone Quantum Diagnostics System (QDS) with the published Measuring Energy Expenditure in ECMO patients (MEEP) approach, which calculates sequential VO2 and VCO2 values via blood gas analysis and a physiologic gas content model. Thirty-nine datasets were acquired during routine venovenous ECMO intensive care treatment and analyzed. VO2 was clinically relevant underestimated via the blood-sided measurement of the QDS compared to the MEEP approach (mean difference −42.61 ml/min, limits of agreement [LoA] −2.49/−87.74 ml), which could be explained by the missing dissolved oxygen fraction of the QDS equation. Analysis of VCO2 showed scattered values with wide limits of agreement (mean difference 54.95 ml/min, LoA 231.26/−121.40 ml/min) partly explainable by a calculation error of the QDS. We described potential confounders of gas-sided measurements in general which need further investigation and recommendations for enhanced devices.
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