Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

Kim R. Derespina; Shivanand S. Medar; Scott I. Aydin; Shubhi Kaushik; Awni Al-Subu; George Ofori-Amanfo

doi:10.1055/s-0040-1718375

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2022; 11(02): 109-113
DOI: 10.1055/s-0040-1718375

Original Article

Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

Kim R. Derespina

¹Division of Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States

,

Shivanand S. Medar

¹Division of Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States

,

Scott I. Aydin

²Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, United States

,

Shubhi Kaushik

²Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, United States

,

Awni Al-Subu

³Division of Pediatric Critical Care Medicine, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

,

George Ofori-Amanfo

²Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, United States

› Author Affiliations

Abstract

The kinetics of carbon dioxide elimination (VCO₂) may be used as a surrogate for pulmonary blood flow. As such, we can apply a novel use of volumetric capnography to assess hemodynamic stability in patients requiring extracorporeal membrane oxygenation (ECMO). We report our experience of pediatric patients requiring ECMO support who were monitored using volumetric capnography. We describe the use of VCO₂ and its association with successful decannulation. This is a prospective observational study of pediatric patients requiring ECMO support at The Children's Hospital at Montefiore from 2017 to 2019. A Respironics NM3 monitor was applied to each patient. Demographics, hemodynamic data, blood gases, and VCO₂ (mL/min) data were collected. Data were collected immediately prior to and after decannulation. Over the course of the study period, seven patients were included. Predecannulation VCO₂ was higher among patients who were successfully decannulated than nonsurvivors (109 [35, 230] vs. 12.4 [7.6, 17.2] mL/min), though not statistically significant. Four patients (57%) survived without further mechanical support; two (29%) died, and one (14%) was decannulated to Berlin. Predecannulation VCO₂ appears to correlate with hemodynamic stability following decannulation. This case series adds to the growing literature describing the use of volumetric capnography in critical care medicine, particularly pediatric patients requiring ECMO. Prospective studies are needed to further elucidate the use of volumetric capnography and optimal timing for ECMO decannulation.

Keywords

ECMO - device - noninvasive

Full Text

References

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