Lung Management with Perfluorocarbon Liquid Ventilation Improves Pulmonary Function and Gas Exchange During Extracorporeal Membrane Oxygenation (ECMO)

Abstract

We investigated whether pulmonary function and gas exchange would improve with liquid perfluorocarbon ventilation (LV) during ECMO for severe respiratory failure. Lung injury was induced in 11 young sheep 15.1 ± 3.7 kg in weight utilizing right atrial injection of 0.07 cc/kg oleic acid followed by saline pulmonary lavage. When (A-a)DO₂ ± 600 mmHg and PaO₂ ± 50 mmHg with FiO₂ = 1.0, ECMO was instituted. Animals were then ventilated with either standard ECMO “lung rest” gas ventilator settings (ECMO, n=5) or with “total” liquid ventilation at standard ventilator device settings (LIQ-ECMO, n=6) utilizing perflubron (perfluooctyl bromide, LiquiventTM; Alliance Pharmaceutical Corp.). After 3 hours on ECMO, pulmonary physiologic shunt decreased (ECMO = 88 ± 11% vs LIQ-ECMO = 31 ± 1%; p <. 001) and pulmonary compliance increased (ECMO = 0.50 ± 0.06 cc/cmH₂O/kg vs. LIQ-ECMO = 1.04 ± 0.19 cc/cmH₂O/kg; p <. 001). The ECMO flow rate required to maintain the PaO₂ in the 50-80 mmHg range was decreased significantly (ECMO = 116 ± 14 ml/kg/min vs. LIQ-ECMO = 14 ± 5 ml/kg/min; p <. 001). In this model requiring extracorporeal support for severe respiratory failure, lung management with liquid ventilation improves pulmonary function and gas exchange.