The safe addition of nitric oxide to the sweep gas of the extracorporeal membrane oxygenation circuit in a pediatric cardiac intensive care unit

Michael A Brock; Mohammed Ebraheem; Andrew Jaudon; Sukumar Suguna Narasimhulu; Zasha Vazquez-Colon; Joseph Philip; Dalia Lopez-Colon; Jeffrey P Jacobs; Mark S Bleiweis; Giles J Peek

doi:10.1177/02676591241246079

The safe addition of nitric oxide to the sweep gas of the extracorporeal membrane oxygenation circuit in a pediatric cardiac intensive care unit

Perfusion. 2024 Apr 6:2676591241246079. doi: 10.1177/02676591241246079. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, USA.
² Department of Pediatrics, Division of Cardiology, Stanford University, Palo Alto, CA, USA.
³ Department of Respiratory Care, ECMO coordinator, UF Health Shands Teaching Hospital, Gainvesville, FL, USA.
⁴ Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, FL, USA.

PMID: 38581646
DOI: 10.1177/02676591241246079

Abstract

Background: Nitric Oxide (NO) is a naturally occurring modulator of inflammation found in the human body. Several studies in the pediatric cardiothoracic surgery literature have demonstrated some beneficial clinical effects when NO is added to the sweep gas of the cardiopulmonary bypass circuit.Purpose: Our primary aim was to determine the safety of incorporating nitric oxide into the oxygenator sweep gas of the extracorporeal membrane oxygenation (ECMO) circuit. Secondarily, we looked at important clinical outcomes, such as survival, blood product utilization, and common complications related to ECMO.Methods: We performed a single center, retrospective review of all patients at our institution who received ECMO between January 1, 2017 and March 31, 2023. We began additing NO to the ECMO sweep gas in 2019. Results: There were no instances of clinically significant methemoglobinemia with the addition of NO to the sweep gas (0% vs 0%, p = 1). The median daily methemoglobin level was higher in those who received NO via the sweep gas when compared to those who did not (1.6 vs 1.1, p = <0.001). Conclusions: The addition of NO to the sweep gas of the ECMO circuit is safe.

Keywords: cardiogenic shock; cardiothoracic surgery; congenital heart disease; extracorporeal membrane oxygenation; nitric oxide; respiratory failure.