Continuous monitoring of membrane lung carbon dioxide removal during ECMO: experimental testing of a new volumetric capnometer

Alice Montalti, Mirko Belliato, Sandro Gelsomino, Sandro Nalon, Francesco Matteucci, Orlando Parise, Monique de Jong, Maged Makhoul, Daniel M. Johnson, Roberto Lorusso

Research output: Contribution to journalArticle

Abstract

Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient–machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V′CO 2 ML), to help in estimating the oxygenator performance, in terms of CO 2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO 2 RESET , by Eurosets srl, Medolla, Italy) device was evaluated for V′CO 2 ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95% of differences were between d − 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V′CO 2 ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95% confidence interval limits of agreement) was 3.86% (12.07-4.35%) for V′CO 2 ML and 2.62% (8.96-14.20%) for VDsML. A negative proportional bias for V′CO 2 ML estimation with the new device was observed with a mean of 3.86% (12.07-4.35%). No correlations were found between differences in the coupled V′CO 2 ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V′CO 2 ML showed strong correlation (r s = 0.991; p = 0.0005), as did VDsML calculations (r s = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO 2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.

Original languageEnglish
JournalPerfusion (United Kingdom)
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Variable frequency oscillators
Carbon Dioxide
Carbon dioxide
Carbon Monoxide
monitoring
Membranes
Oxygenators
Equipment and Supplies
Lung
Monitoring
Gases
Testing
Extracorporeal Membrane Oxygenation
Cardiogenic Shock
Flow of gases
Italy
Blood
Swine
Myocardial Infarction
Confidence Intervals

Keywords

  • capnometer
  • ECLS
  • ECMO
  • extracorporeal membrane oxygenation monitoring
  • membrane lung carbon dioxide removal
  • membrane lung function
  • oxygenator performance
  • V′CO

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Continuous monitoring of membrane lung carbon dioxide removal during ECMO : experimental testing of a new volumetric capnometer. / Montalti, Alice; Belliato, Mirko; Gelsomino, Sandro; Nalon, Sandro; Matteucci, Francesco; Parise, Orlando; de Jong, Monique; Makhoul, Maged; Johnson, Daniel M.; Lorusso, Roberto.

In: Perfusion (United Kingdom), 01.01.2019.

Research output: Contribution to journalArticle

Montalti, Alice ; Belliato, Mirko ; Gelsomino, Sandro ; Nalon, Sandro ; Matteucci, Francesco ; Parise, Orlando ; de Jong, Monique ; Makhoul, Maged ; Johnson, Daniel M. ; Lorusso, Roberto. / Continuous monitoring of membrane lung carbon dioxide removal during ECMO : experimental testing of a new volumetric capnometer. In: Perfusion (United Kingdom). 2019.
@article{e4149b4bae0e4d2b81f383c13868351a,
title = "Continuous monitoring of membrane lung carbon dioxide removal during ECMO: experimental testing of a new volumetric capnometer",
abstract = "Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient–machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V′CO 2 ML), to help in estimating the oxygenator performance, in terms of CO 2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO 2 RESET ™ , by Eurosets srl, Medolla, Italy) device was evaluated for V′CO 2 ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95{\%} of differences were between d − 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V′CO 2 ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95{\%} confidence interval limits of agreement) was 3.86{\%} (12.07-4.35{\%}) for V′CO 2 ML and 2.62{\%} (8.96-14.20{\%}) for VDsML. A negative proportional bias for V′CO 2 ML estimation with the new device was observed with a mean of 3.86{\%} (12.07-4.35{\%}). No correlations were found between differences in the coupled V′CO 2 ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V′CO 2 ML showed strong correlation (r s = 0.991; p = 0.0005), as did VDsML calculations (r s = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO 2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.",
keywords = "capnometer, ECLS, ECMO, extracorporeal membrane oxygenation monitoring, membrane lung carbon dioxide removal, membrane lung function, oxygenator performance, V′CO",
author = "Alice Montalti and Mirko Belliato and Sandro Gelsomino and Sandro Nalon and Francesco Matteucci and Orlando Parise and {de Jong}, Monique and Maged Makhoul and Johnson, {Daniel M.} and Roberto Lorusso",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0267659119833233",
language = "English",
journal = "Perfusion",
issn = "0267-6591",
publisher = "SAGE Publications Ltd",

}

TY - JOUR

T1 - Continuous monitoring of membrane lung carbon dioxide removal during ECMO

T2 - experimental testing of a new volumetric capnometer

AU - Montalti, Alice

AU - Belliato, Mirko

AU - Gelsomino, Sandro

AU - Nalon, Sandro

AU - Matteucci, Francesco

AU - Parise, Orlando

AU - de Jong, Monique

AU - Makhoul, Maged

AU - Johnson, Daniel M.

AU - Lorusso, Roberto

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient–machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V′CO 2 ML), to help in estimating the oxygenator performance, in terms of CO 2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO 2 RESET ™ , by Eurosets srl, Medolla, Italy) device was evaluated for V′CO 2 ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95% of differences were between d − 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V′CO 2 ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95% confidence interval limits of agreement) was 3.86% (12.07-4.35%) for V′CO 2 ML and 2.62% (8.96-14.20%) for VDsML. A negative proportional bias for V′CO 2 ML estimation with the new device was observed with a mean of 3.86% (12.07-4.35%). No correlations were found between differences in the coupled V′CO 2 ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V′CO 2 ML showed strong correlation (r s = 0.991; p = 0.0005), as did VDsML calculations (r s = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO 2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.

AB - Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient–machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V′CO 2 ML), to help in estimating the oxygenator performance, in terms of CO 2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO 2 RESET ™ , by Eurosets srl, Medolla, Italy) device was evaluated for V′CO 2 ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95% of differences were between d − 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V′CO 2 ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95% confidence interval limits of agreement) was 3.86% (12.07-4.35%) for V′CO 2 ML and 2.62% (8.96-14.20%) for VDsML. A negative proportional bias for V′CO 2 ML estimation with the new device was observed with a mean of 3.86% (12.07-4.35%). No correlations were found between differences in the coupled V′CO 2 ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V′CO 2 ML showed strong correlation (r s = 0.991; p = 0.0005), as did VDsML calculations (r s = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO 2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.

KW - capnometer

KW - ECLS

KW - ECMO

KW - extracorporeal membrane oxygenation monitoring

KW - membrane lung carbon dioxide removal

KW - membrane lung function

KW - oxygenator performance

KW - V′CO

UR - http://www.scopus.com/inward/record.url?scp=85063042645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063042645&partnerID=8YFLogxK

U2 - 10.1177/0267659119833233

DO - 10.1177/0267659119833233

M3 - Article

AN - SCOPUS:85063042645

JO - Perfusion

JF - Perfusion

SN - 0267-6591

ER -