End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

Takashi Naruke; Takayuki Inomata; Hiroshi Imai; Tomoyoshi Yanagisawa; Emi Maekawa; Tomohiro Mizutani; Tsutomu Osaka; Hisahito Shinagawa; Toshimi Koitabashi; Mototsugu Nishii; Ichiro Takeuchi; Hitoshi Takehana; Naoyoshi Aoyama; Tohru Izumi

doi:10.1536/ihj.51.116

Clinical Studies

End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

Takashi Naruke, Takayuki Inomata, Hiroshi Imai, Tomoyoshi Yanagisawa, Emi Maekawa, Tomohiro Mizutani, Tsutomu Osaka, Hisahito Shinagawa, Toshimi Koitabashi, Mototsugu Nishii, Ichiro Takeuchi, Hitoshi Takehana, Naoyoshi Aoyama, Tohru Izumi

Author information

Takashi Naruke
Department of Cardio-Angiology, Kitasato University School of Medicine
Takayuki Inomata
Department of Cardio-Angiology, Kitasato University School of Medicine
Hiroshi Imai
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine
Tomoyoshi Yanagisawa
Department of Cardio-Angiology, Kitasato University School of Medicine
Emi Maekawa
Department of Cardio-Angiology, Kitasato University School of Medicine
Tomohiro Mizutani
Department of Cardio-Angiology, Kitasato University School of Medicine
Tsutomu Osaka
Department of Cardio-Angiology, Kitasato University School of Medicine
Hisahito Shinagawa
Department of Cardio-Angiology, Kitasato University School of Medicine
Toshimi Koitabashi
Department of Cardio-Angiology, Kitasato University School of Medicine
Mototsugu Nishii
Department of Cardio-Angiology, Kitasato University School of Medicine
Ichiro Takeuchi
Department of Cardio-Angiology, Kitasato University School of Medicine
Hitoshi Takehana
Department of Cardio-Angiology, Kitasato University School of Medicine
Naoyoshi Aoyama
Department of Cardio-Angiology, Kitasato University School of Medicine
Tohru Izumi
Department of Cardio-Angiology, Kitasato University School of Medicine

Keywords: End-tidal carbon dioxide, Extracorporeal membrane oxygenation, Hemodynamic deterioration, Clinical predictor, Weaning

JOURNAL FREE ACCESS

2010 Volume 51 Issue 2 Pages 116-120

DOI https://doi.org/10.1536/ihj.51.116

Details

Abstract

Although extracorporeal membrane oxygenation (ECMO) is widely used as temporary circulation support, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning off.
Twenty-five patients supported by ECMO due to hemodynamic deterioration were divided into 2 groups according to their outcome: weaned ECMO (W: n = 18) or not (NW: n = 7). In the W group, we examined the differences in parameters between the 2 time points, ECMO introduction, and the reduction in ECMO flow to 40% of the initial setting known as the conventional recovery point (C-point). Significant differences were observed in systolic pulmonary artery pressure, the cardiac index measured by the thermodilution method, C-reactive protein, lactate, base excess, and the end-tidal CO₂ concentration (ETCO₂). Next, by closely examining these 6 parameters measured every 12 hours, we found that only ETCO₂ had always changed steeply, like a ‘flexion point’ (E-point), in all W cases, but not in NW. The E-point was defined as an initial increase in ETCO₂ of ≥ 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours. E-points appeared as much as 95 ± 60 hours earlier than C-points and also preceded weaning off of ECMO.
ETCO₂ can be a useful continuous parameter for predicting the adequate timing of weaning off of ECMO for circulatory failure at the bedside.

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