Cardiac Arrest, Pulmonary Injury
Conditions
Brief summary
There is limited data on the respiratory system mechanics and ideal mode of ventilation for patients on veno-arterial extra-corporeal membrane oxygenation (VA ECMO) post cardiac arrest. In this observational study, the investigators will review and/or obtain laboratory, hemodynamic, respiratory system mechanical, and clinical data from patients on VA ECMO. The specific aims of this study are as follows: Aim 1: To characterize the lung ventilation strategy employed in patients on VA ECMO and its success. Aim 2: To characterize respiratory system mechanics while on ECMO using esophageal manometry and Electrical Impedance Tomography (EIT). Aim 3: To characterize right heart function and pulmonary vascular hemodynamics on the employed ventilation strategy. The overarching hypothesis is that fine-tuned individualized ventilation might be superior to an algorithm that does not account for cardiac and pulmonary functions. Therefore, the aims of this study are to identify areas in which the ventilation strategy may theoretically be suboptimal, which will guide future interventional studies investigating alternatives methods of ventilation which may reduce time on the ventilator after cardiac arrest, time in the intensive care unit, and need for veno-venous ECMO.
Interventions
PROCEDUREVeno-arterial extracorporeal membrane oxygenation (VA-ECMO)
VA-ECMO used for resuscitation after cardiac arrest
DEVICEElectrical Impedance Tomography (EIT)
EIT used to demonstrate ventilation and perfusion distribution in intubated patients on VA-ECMO
Sponsors
Massachusetts General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* On VA ECMO after cardiac arrest * Between 18 and 85 years of age * Has an orogastric or nasogastric tube with esophageal balloon capabilities in place
Exclusion criteria
* Known pre-existing significant pulmonary pathology * Pacemaker or implanted cardiac defibrillator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of total distribution of ventilation by region, on given ventilator settings | Within 24-48 hours of ECMO cannulation | EIT will be used to determine the percent of total ventilation occurring in each of four lung quadrants on an axial plane: right upper, left upper, right lower, and left lower. |
Secondary
| Measure | Time frame |
|---|---|
| Need to transition to VV-ECMO | 14 days, 90 days |
| Time on mechanical ventilation | 14 days, 90 days |
| Time on VA-ECMO | 14 days, 90 days |
| 90-day mortality | 90 days |
| Incidence of ventilator-associated pneumonia | 14 days, 90 days |
| Time in ICU | 14 days, 90 days |
Countries
United States
Outcome results
None listed