This seems like such a basic question and yet the answer is not an answer at all.  Rather it is an educated opinion.  Today we ask the question – Should we blend ECPR patients?

Here’s the basic problem.  We think hyperoxemia in critically ill patients is bad (Remember hyperoxemia is high oxygen in blood, hyperoxia is high oxygen in the tissue).  We think that hypoxemia in critically ill patients is bad.  So if a patient gets put on ECMO and we can make the oxygen level coming out of the machine whatever level we want, what level should we set it at?

Well, today, Trina Augustin teaches how this seemingly simple problem is actually quite complex.  Trina is an ECMO superstar.  She practices at Mayo in Rochester as CV Intensivist with a background in CC/EM.  She teaches the most complex part of Reanimate – post pump critical care and yes she cannulates patients as well.  Listen to Zack and Trina banter over this complex topic specifically focusing on the release of the Blender Trial.

EMCRIT ECMO Podcast with Trina that is awesome! – CV-EMCrit – MCS Minute Series: Differential Gas Exchange on Peripheral Femoral VA ECMO with Trina

Bibliography:

Winiszewski H, Guinot PG, Schmidt M, Besch G, Piton G, Perrotti A, Lorusso R, Kimmoun A, Capellier G. Optimizing PO2 during peripheral veno-arterial ECMO: a narrative review. Crit Care. 2022 Jul 26;26(1):226. doi: 10.1186/s13054-022-04102-0. PMID: 35883117; PMCID: PMC9316319.

Bureau C, Schmidt M, Chommeloux J, Rivals I, Similowski T, Hékimian G, Luyt CE, Niérat MC, Dangers L, Dres M, Combes A, Morélot-Panzini C, Demoule A. Increasing Sweep Gas Flow Reduces Respiratory Drive and Dyspnea in Nonintubated Venoarterial Extracorporeal Membrane Oxygenation Patients: A Pilot Study. Anesthesiology. 2024 Jul 1;141(1):87-99. doi: 10.1097/ALN.0000000000004962. PMID: 38436930.

Burrell A, Ng S, Ottosen K, Bailey M, Buscher H, Fraser J, Udy A, Gattas D, Totaro R, Bellomo R, Forrest P, Martin E, Reid L, Ziegenfuss M, Eastwood G, Higgins A, Hodgson C, Litton E, Nair P, Orford N, Pellegrino V, Shekar K, Trapani T, Pilcher D. Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial: Study Protocol and Statistical Analysis Plan. Crit Care Resusc. 2023 Aug 4;25(3):118-125. doi: 10.1016/j.ccrj.2023.06.001. Erratum in: Crit Care Resusc. 2024 Feb 01;26(1):60. doi: 10.1016/j.ccrj.2024.01.003. PMID: 37876374; PMCID: PMC10581278.