LUNG MANAGEMENT WITH PERFLUOROCARBON LIQUID VENTILATION IMPROVES PULMONARY-FUNCTION AND GAS-EXCHANGE DURING EXTRACORPOREAL MEMBRANE-OXYGENATION (ECMO)

We investigated whether pulmonary function and gas exchange would impr ove with liquid perfluorocarbon ventilation (LV) during ECMO for sever e 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 ol eic acid followed by saline pulmonary lavage. When (A-a)DO2 greater th an or equal to 600 mmHg and PaO2 less than or equal to 50 mmHg with Fi O(2) = 1.0, ECMO was instituted. Animals were then ventilated with eit her standard ECMO ''lung rest'' gas ventilator settings (ECMO, n=5) or with ''total'' liquid ventilation at standard ventilator device setti ngs (LIQ-ECMO, n=6) utilizing perflubron (perfluooctyl bromide, Liquiv ent(TM); Alliance Pharmaceutical Corp.). After 3 hours on ECMO, pulmon ary physiologic shunt decreased (ECMO = 88 +/- 11% vs LIQ-ECMO = 31 +/ - 1%; p < .001) and pulmonary compliance increased (ECMO = 0.50 +- 0.0 6 cc/cmH(2)O/kg vs. LIQ-ECMO = 1.04 +/- 0.19 cc/cmH(2)O/kg; p < .001). The ECMO flow rate required to maintain the PaO2 in the 50-80 mmHg ra nge was decreased significantly (ECMO = 116 +/- 14 ml/kg/min vs. LIQ-E CMO = 14 +/- 5 ml/kg/min; p < .001). In this model requiring extracorp oreal support for severe respiratory failure, lung management with liq uid ventilation improves pulmonary function and gas exchange.