Aortic Arch Perfusion Modes in Partial and Total Cardiopulmonary Bypass

Abstract

Prolonged extracorporeal membrane oxygenation (ECMO) has been performed with some success in the treatment of clinical acute respiratory failure in recent years [10]. The extracorporeal circuit generally used in ECMO is a partial cardiopulmonary bypass (CPB) with closed chest through femoral or axillary can-nulae. To return arterialized blood to the brain through such routes is difficult because the carotid and vertebral arteries branch off upflow on the aortic arch. We have seen sudden brain death in a patient on EMCO during bronchoscopic apnea due to acute hypoxia despite a right subclavian arterial return. We, therefore, studied more sophisticated modes of aortic arch perfusion in ECMO dogs, using curare-induced apnea as the model of pulmonary failure. These experiments showed that a double carotid-femoral arterial return in the apneic dog can supply the heart and brain with oxygenated blood while reducing myocardial metabolism [2, 7]. However, obvious differences in the anatomy and importance of the carotid arteries in the dog and in man motivated us to study a second group of dogs using an especially long femoral cannula, designed by Zapol for aortic root return [10].

This work was supported by grants 1208, 20470 and 3.4546 of the Belgian Fonds de la Recherche Scientifique Médicale. The authors acknowledge the collaboration of Dr. Ch. Derks, working with partial financial aid from the E.E.C. and in the frame of the Association Euratom-University of Pisa -Université Libre de Bruxelles.