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Use of Exhaled Carbon Dioxyde for Monitoring the Native Cardiac Function During Mechanical Circulatory Support With Venoarterial By-pass in Intensive Care Unit (CAPNOECMO)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT03323268
Recruitment Status : Completed
First Posted : October 26, 2017
Last Update Posted : October 26, 2017
Information provided by (Responsible Party):
University Hospital, Montpellier

Brief Summary:
Cardiogenic shock, the most severe form of acute heart failure, is a critical situation where the body cells lack of oxygen because of cardiac dysfunction. The failure of pharmacological therapy to maintain adequate perfusion has led to attempts to improve the circulation by the use of mechanical circulatory support devices. Peripheral veno-arterial support (PVA-ECMO) is the most frequently used device. It consists of extracorporeal circulatory support. Venous blood is aspirated via the right atrium and reinjected into the descending aorta via the femoral artery. As a consequence of this by-pass, pulmonary artery flow and residual left ventricle ejection can fall drastically until zero in the most severe patients. A minimal transpulmonary blood flow is crucial to avoid left heart cavities and pulmonary artery and left heart cavities thrombosis. The gold standard technique to monitor transpulmonary blood flow is right-heart cavities catheterism (Swan-Ganz catheter) but it represents major limits: invasive technique, limited duration of utilization because of septic risk, physical limit of flow measurement (under 1 liter/minute). End-tidal pressure carbon dioxide (Pet CO2) monitoring (or capnography) is a routine and non-invasive measure in ventilated patients. Previous studies have shown that changes in PetCO2 can measure changes in cardiac output in anesthetized patients and that PetCO2 is a useful index of pulmonary artery blood flow during separation from cardiopulmonary bypass. The aim of this study is to demonstrate that PetCO2 is correlated to transpulmonary blood flow in patients under PVA-ECMO and that exhaled CO2 can provide an on-line, continuous, and noninvasive monitor of residual outflow from the heart during PVA-ECMO.

Condition or disease Intervention/treatment
Residual Cardiac Output During PVA-ECMO Device: PetCO2 monitoring

Detailed Description:


This prospective study is conducted since January 2016 in our tertiary ICU and has been approved by our hospital's institutional review board. Informed consent will be obtained from all patients or their surrogates.

Hemodynamic is monitored via a radial arterial catheter for continuous blood pressure monitoring, a pulmonary artery catheter (Swan-Ganz CCOmbo® CCO/SvO2, Edwards Lifesciences) inserted through the superior vena cava (jugular intern or subclavian vein) and transoesophageal echocardiography (TOE) at PVA-ECMO implantation or at operator discretion.

ECMO circuit settings and patients management under ECMO

PVA-ECMO consist of polyvinyl chloride tubing with a membrane oxygenator (PH.I.S.I.O and EOS; Sorin Group, Clamart, France), a centrifugal pump (Stockert; Sorin Group), and percutaneous or surgically inserted arterial and venous femoral cannulae (Fem-Flex and Fem-Track, Edwards Life- sciences, Guyancourt, France) with or without an additional 7 F cannula inserted distally into the femoral artery to prevent lower limb ischemia. An oxygen-air blender (Sechrist Industries, Anaheim, CA) ventilate the membrane oxygenator. Unfractionated heparin is administrated to maintain an activated partial thromboplastin time between 1.5 and 2 times the normal value. The lower speed flow necessary for adequate tissue perfusion is wanted.

Ventilator settings, end-tidal PCO2 monitoring, blood gas analysis and transpulmonary blood flow monitoring

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Study Type : Observational
Actual Enrollment : 39 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Validation of End-tidal CO2 for Transplumonary Blood Flow Monitoring During PVA-ECMO
Actual Study Start Date : January 12, 2016
Actual Primary Completion Date : October 23, 2016
Actual Study Completion Date : October 23, 2017

Intervention Details:
  • Device: PetCO2 monitoring
    CO2 analyzer on ventilator expiratory lane. On-line, continuous, and noninvasive monitor. Routine use in anesthesia and intensive care units.

Primary Outcome Measures :
  1. Assessment of end-tidal pressure CO2 (PetCO2) correlation with pulmonary artery flow [ Time Frame: Up to 5 days ]
    end-tidal pressure CO2 (PetCO2) vs pulmonary artery flow measured by pulmonary catheter or echocardiography

Secondary Outcome Measures :
  1. Assessment of end-tidal pressure CO2 (PetCO2) thresholds to detect pulmonary artery flow < 1 l/min and indexed flow < 1l/min/m2 [ Time Frame: Up to 5 days ]
  2. Assessment of Factors of end-tidal pressure CO2 (PetCO2) variation [ Time Frame: Up to 5 days ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients under mechanical ventilation and PVA-ECMO support

Inclusion Criteria:

  • Patients under mechanical ventilation and PVA-ECMO support with low residual native cardiac output

Exclusion Criteria:

  • age less than 18 years
  • pulmonary disorders with abnormal dead-space (obstructive pulmonary disease; acute respiratory distress syndrome)
  • cardiac shunt (atrial or ventricular communication)
  • significant tricuspid or pulmonary valve disease
  • pulmonary artery catheter implantation contraindicated.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03323268

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Montpellier, France, 34295
Sponsors and Collaborators
University Hospital, Montpellier
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: University Hospital, Montpellier Identifier: NCT03323268    
Other Study ID Numbers: 9653
First Posted: October 26, 2017    Key Record Dates
Last Update Posted: October 26, 2017
Last Verified: July 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: unkown
Keywords provided by University Hospital, Montpellier:
Intensive care
Cardiogenic shock
Peripheral veno-arterial extracorporeal membrane oxygenation
Left ventricular overload
Native cardiac output
Pulmonary artery blood flow
End-tidal carbon dioxide
Swan Ganz catheter
Blood gaz