Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support

Yeh, Yu-Chang; Lee, Chen-Tse; Wang, Chih‐Hsien; Tu, Yu–Kang; Lai, Chien-Heng; Wang, Yin-Chin; Chao, Anne; Huang, Cheng‐Han; Cheng, Ya-Jung; Chen, Yih‐Sharng

doi:10.1186/s13054-018-2081-2

Cited by 45 publications

(38 citation statements)

References 28 publications

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“…Because neither macrocirculatory parameters at 12 hours nor lactate levels or inotropic scores were associated with mortality, the study results suggest that microcirculatory impairment affects prognosis regardless of macrocirculation [34]. In the present study, a PCO 2 gap > 6 mmHg at H6 was associated with early death in patients under VA ECMO.…”

Section: Discussioncontrasting

confidence: 51%

Early veno arterial PCO2 difference is associated with outcome in peripheral veno arterial extracorporeal membrane oxygenation

Ellouze

Nguyen

Missaoui

et al. 2020

Preprint

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Background: Veno arterial membrane oxygenation (VA ECMO) is increasingly used for cardiogenic failure. However, hemodynamic targets for adequate resuscitation remain a challenge. The PCO 2 gap and the ratio between PCO 2 gap and the arteriovenous difference in oxygen (PCO 2 gap/Da–vO 2 ) are marker of peripheral hypoperfusion. We hypothesized that the PCO 2 gap and the PCO 2 gap/Da–vO 2 ratio might be useful parameters in VA ECMO patients. Methods: We conducted an observational prospective study between September 2015 and February 2017. All consecutive patients >18 years of age who had been treated with peripheral VA ECMO for cardiac failure were included. We compared 2 groups of patients: patients who died of any cause under VA ECMO or in the 72h following VA ECMO weaning (early death group) - and patients who survived VA ECMO weaning more than 72h (surviving group). Blood samples were drawn from arterial and venous VA ECMO cannulas at H0 and H6. The ability of PCO 2 gap and PCO 2 gap/Da–vO 2 to discriminate between early mortality and surviving was studied using ROC curves analysis. Results: We included 20 patients in surviving group and 29 in early death group. The PCO 2 gap was higher in the early death group at H6 (7.4 [5.7–10.1] vs. 5.9 [3.8–9.2], p < 0.01). AUC for PCO 2 gap at H6 was 0.76 (0.61–0.92), with a cut-off of 6.2 mmHg. The PCO 2 gap/Da–vO 2 was higher in the early death group at H0 (2.1 [1.5–2.6] vs. 1.2 [0.9–2.4], p < 0.01) and at H6 (2.1 [1.3–2.6] vs. 1.0 [0.8–1.7], p < 0.01). AUC for PCO 2 gap/Da–vO 2 at H0 and H6 were 0.79 and 0.73 respectively; the cut-off value was 1.4. Conclusions: The PCO 2 gap and the PCO 2 gap/Da–vO2 ratio are associated with early death in patients who undergo VA ECMO.

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Section: Discussioncontrasting

confidence: 51%

Early veno arterial PCO2 difference is associated with outcome in peripheral veno arterial extracorporeal membrane oxygenation

Ellouze

Nguyen

Missaoui

et al. 2020

Preprint

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show abstract

“…For all enrolled patients, the placement and principal components of the VA-ECMO were the same as described in our previous study [9]. To avoid possible malperfusion of the distal limb, an antegrade distal perfusion catheter was used when the mean pressure of the superficial femoral artery was below 50 mm Hg [12].…”

Section: Va-ecmo Components and Placementmentioning

confidence: 99%

“…The software was used to automatically calculate TVD. The calculation of PVD was semiautomated using the procedure described in our previous study [9]. The MFI scores were semiquantitatively calculated according to the suggestions made at the roundtable conference [18].…”

Section: Measurements Of Sublingual Microcirculationmentioning

confidence: 99%

Contradictory responses of the microcirculation to changes in extracorporeal membrane oxygenation pump flow in patients on venoarterial extracorporeal membrane oxygenation: a prospective observational study

Wei¹,

Wang²,

Chan³

et al. 2020

Preprint

Self Cite

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Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining tissue and organ perfusion in patients with cardiogenic shock. Determining the optimal VA-ECMO pump flow rate to maintain adequate tissue perfusion remains a clinical challenge. Poor microcirculation is associated with higher mortality in patients using VA-ECMO. Change in VA-ECMO pump flow is expected to result in a coherent change in microcirculatory blood flow, but this has not been investigated. This study investigated the effect of altering VA-ECMO pump flow rate on sublingual microcirculation. Methods: Sublingual microcirculation images were recorded using an incident dark-field hand held vital microscope at two time points, within 24 h (T1) and at 24-48 h (T2) after VA-ECMO placement. Microcirculation was measured before and 5 minutes after the changes in VA-ECMO pump flow rate at each time point. Events of changing VA-ECMO pump flow rate at T1 and T2 were divided into four groups according to changes in perfused vessel density (PVD): Group A, increased pump flow rate and increased or sustained PVD; Group B, increased pump flow rate and decreased PVD; Group C, decreased pump flow rate and increased or sustained PVD; and Group D, decreased pump flow rate and decreased PVD. The microcirculatory parameters, clinical parameters, and prognosis of each subgroup were recorded. Clinical parameters on 14-day and 28-day survivors and non-survivors were also compared. Results: A total of 25 patients were enrolled, and 38 events with good-quality images at T1 and T2 were categorized. Opposing response of microcirculation was observed in 43.5% of events when VA-ECMO pump flow rate was increased. Microcirculation was decreased in 33.4% of events when VA-ECMO pump flow rate was reduced. No predictive values in microcirculatory or macrocirculatory parameters before changing VA-ECMO pump flow rate were identified. Conclusions: Changes in VA-ECMO pump flow rate may have opposing effects on sublingual microcirculatory functional capillary density. We suggest that tandem measurements of microcirculation before and after altering the VA-ECMO pump flow may help to ensure optimal tissue perfusion.

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“…We read with great interest the article by Yeh et al about microcirculation in cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation (VA ECMO) [ 1 ]. We would like to commend the authors for their efforts to shed some light on this promising field.…”

mentioning

confidence: 99%

“…The authors outlined the usefulness of early microcirculatory parameters in predicting 28-day mortality in CS shortly after VA ECMO implantation [ 1 ]. They found a well-known lack of relationship between microcirculation and macrocirculation in CS [ 4 ].…”

mentioning

confidence: 99%

Microcirculation in cardiogenic shock supported with extracorporeal membrane oxygenation: the need for a homogeneous population and strict evolution assessment

et al. 2018

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Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support

Cited by 45 publications

References 28 publications

Early veno arterial PCO2 difference is associated with outcome in peripheral veno arterial extracorporeal membrane oxygenation

Early veno arterial PCO2 difference is associated with outcome in peripheral veno arterial extracorporeal membrane oxygenation

Contradictory responses of the microcirculation to changes in extracorporeal membrane oxygenation pump flow in patients on venoarterial extracorporeal membrane oxygenation: a prospective observational study

Microcirculation in cardiogenic shock supported with extracorporeal membrane oxygenation: the need for a homogeneous population and strict evolution assessment

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