Position paper on the physiology and nomenclature of dual circulation during venoarterial ECMO in adults

Intensive Care Med. 2024 Dec;50(12):1994-2004. doi: 10.1007/s00134-024-07645-8. Epub 2024 Nov 18.

Abstract

When native blood flow through the aorta from the adult heart and lungs meets retrograde blood flow from an artificial heart and lung during venoarterial extracorporeal membrane oxygenation (VA-ECMO), the result is the creation of two separate circulations on either side of the blood flow mixing point. This phenomenon is known as dual circulation and is characterized by different content of oxygen and carbon dioxide between the circulations. There is currently a lack of clarity surrounding the nomenclature to describe this physiologic phenomenon in VA-ECMO and thus we endeavor to name and define these terms to facilitate clear communication and proper clinical management of these patients.

Keywords: Differential carbon dioxide; Differential oxygenation; Dual circulation; Extracorporeal life support; Extracorporeal membrane oxygenation; Mixing point.

Publication types

  • Review

MeSH terms

  • Adult
  • Carbon Dioxide / blood
  • Extracorporeal Membrane Oxygenation* / methods
  • Humans
  • Oxygen / blood
  • Terminology as Topic*

Substances

  • Oxygen
  • Carbon Dioxide