VA-ECMO
Conditions
Keywords
Ventilation / perfusion, ECMO, Mechanical Ventilation
Brief summary
The aim of this study is to characterize ventilation/perfusion (V/Q) matching in adult patients receiving peripheral VA ECMO support while on mechanical ventilation, and to evaluate the impact of PEEP titration guided by Electrical Impedance Tomography (EIT) and esophageal pressure measurements on lung mechanics and V/Q optimization.
Detailed description
The investigators hypothesize that an individualized PEEP titration guided by esophageal pressure measurements and Electrical Impedance Tomography can reduce lung overdistention, enhance lung recruitment, and improve V/Q matching by optimizing regional ventilation and perfusion also in VA ECMO. Our objectives are: 1. To describe V/Q matching in patients undergoing mechanical ventilation during peripheral VA ECMO support. 2. To explore the impact of PEEP titration based on esophageal pressure and EIT in terms of lung mechanics and V/Q matching.
Interventions
OTHERPhysiology measurements
Measurement of lung perfusion (via EIT) and transpulmonary pressure (via esophageal manometry) during decremental PEEP trial
Sponsors
Beth Israel Deaconess Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults (≥18 years) undergoing mechanical ventilation during peripheral VA ECMO support for cardiogenic shock, cardiac arrest, or refractory heart failure. * On ECMO support for at least 6 hours * Swan-Ganz catheter required as standard clinical care * Clinically stable in the estimation of the study investigator
Exclusion criteria
* Contraindications to EIT (e.g., presence of electrical interference) * Patients without pulmonary flow (non-pulsatile pulmonary pressure) * Patients with known pulmonary embolism * Imminent withdrawal of life support
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| V/Q match | 1 hour | Primary outcome measure: Reduction in shunt fraction (expressed in %) Secondary outcome measure: Reduction in dead space (expressed as volume) Respiratory mechanics will be recorded before and after best PEEP. Ventilation (L/min)/Perfusion (L/min) \[V/Q\] ratio comparing baseline with best PEEP (after PEEP optimization trial). |
Countries
United States
Outcome results
None listed