The response of the microcirculation to mechanical support of the heart in critical illness

Akın, Şakir; Kara, Atila; Uil, Corstiaan A. den; İnce, Can

doi:10.1016/j.bpa.2016.10.001

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…Even though global hemodynamics were comparable between patients with and without successful weaning, microcirculatory parameters were significantly different. The occurrence of such disassociation between macro-circulation and microcirculation, referred to as a loss of hemodynamic coherence, has been described before in other conditions of cardiovascular compromise [ 11 , 23 – 28 ].…”

Section: Discussionmentioning

confidence: 94%

“…In these measurements, the hyperemic phase after the resolution of stenosis also occurs within 2 minutes [ 31 ]. Several studies have been performed on microcirculatory alterations during ECMO [ 32 , 33 ] with differing results concerning the relationship between global hemodynamics to the microcirculation [ 23 , 34 – 38 ]. In a recent study, however, we found a significant predictive value of sublingual measured perfused vessel density in VA-ECMO patients for survival in the ICU [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

et al. 2017

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BackgroundVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters.MethodsWeaning was performed by decreasing the VA-ECMO flow to 50% (F50) from the baseline. The endpoint of the study was successful VA-ECMO explantation within 48 hours after weaning. The response of sublingual microcirculation to a weaning attempt (WA) was evaluated. Microcirculation was measured in one sublingual area (single spot (ss)) using CytoCam IDF imaging during WA. Total vessel density (TVDss) and perfused vessel density (PVDss) of the sublingual area were evaluated before and during 50% flow reduction (TVDssF50, PVDssF50) after a WA and compared to conventional echocardiographic parameters as indicators of the success or failure of the WA.ResultsPatients (n = 13) aged 49 ± 18 years, who received VA-ECMO for the treatment of refractory CS due to pulmonary embolism (n = 5), post cardiotomy (n = 3), acute coronary syndrome (n = 2), myocarditis (n = 2) and drug intoxication (n = 1), were included. TVDssF50 (21.9 vs 12.9 mm/mm2, p = 0.001), PVDssF50 (19.7 vs 12.4 mm/mm2, p = 0.01) and aortic velocity–time integral (VTI) at 50% flow reduction (VTIF50) were higher in patients successfully weaned vs not successfully weaned. The area under the curve (AUC) was 0.99 vs 0.93 vs 0.85 for TVDssF50 (small vessels) >12.2 mm/mm2, left ventricular ejection fraction (LVEF) >15% and aortic VTI >11 cm. Likewise, the AUC was 0.91 vs 0.93 vs 0.85 for the PVDssF50 (all vessels) >14.8 mm/mm2, LVEF >15% and aortic VTI >11 cm.ConclusionThis study identified sublingual microcirculation as a novel potential marker for identifying successful weaning from VA-ECMO. Sustained values of TVDssF50 and PVDssF50 were found to be specific and sensitive indicators of successful weaning from VA-ECMO as compared to echocardiographic parameters.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1855-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

et al. 2017

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“…Previous studies documented loss of haemodynamic coherence between macrocirculatory and microcirculatory perfusion parameters. 6,[16][17][18] This indicates that normal macrocirculatory perfusion parameters do not necessarily ensure perfusion, and thus oxygen exchange, at the microvascular level. The present study is the first to demonstrate that loss of haemodynamic coherence between macrocirculatory parameters and microcirculatory perfusion parameters translates into meaningful prognostic value.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy

Wijntjens

Fengler²,

Fuernau

et al. 2019

European Heart Journal: Acute Cardiovascular Care

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Background: After early revascularisation, restoration of macrocirculatory perfusion parameters is the primary objective in the management of cardiogenic shock complicated acute myocardial infarction. Nevertheless, vital organ perfusion may be compromised at the systemic microcirculatory level, even in patients with preserved macrohaemodynamics. Microvascular perfusion was shown to have independent prognostic value for early mortality. The present study aims to compare the prognostic value of microcirculatory versus macrocirculatory perfusion parameters. Methods: This substudy of the culprit lesion-only percutaneous coronary intervention versus multivessel percutaneous coronary intervention in cardiogenic shock (CULPRIT-SHOCK) trial examined the sublingual capillary network using videomicroscopy post-percutaneous coronary intervention to determine the proportion of perfused capillaries (<20 µm) and perfused capillary density. Thirty-day follow-up was performed to obtain the occurrence of a combined clinical endpoint of all-cause death and renal replacement therapy. Results: Videomicroscopy measurements were performed in 66 patients. There was a significant adjusted association between microcirculatory perfusion parameters and the combined clinical endpoint (proportion of perfused capillaries: P=0.020; perfused capillary density: P=0.035), whereas there was no significant adjusted association between macrocirculatory perfusion parameters and the combined clinical endpoint (systolic blood pressure: P=0.205). Normotensive patients with compromised microcirculatory perfusion parameters had a higher risk of the combined clinical endpoint than normotensive patients with preserved microcirculatory perfusion parameters (proportion of perfused capillaries: Breslow P=0.014; perfused capillary density: Breslow P=0.076). Conclusions: There is a significant and independent association between microcirculatory perfusion parameters perfused capillary density and proportion of perfused capillaries and the combined clinical endpoint of all-cause death and renal replacement therapy at 30 days follow-up. In patients with loss of haemodynamic coherence between microcirculatory and macrocirculatory perfusion parameters, microcirculatory perfusion parameters confer dominant prognostic value.

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“…Most vital monitoring devices focus on macrocirculatory measures, such as stroke volume, cardiac output, heart rate, central venous pressure and mean arterial pressure, based on the hypothesis that changes in microcirculatory perfusion occur in parallel to those in macrocirculatory perfusion. However, several studies have shown that during shock state, restoration of the macrocirculation is not necessarily correlated with the recovery of the microcirculation to baseline levels [2][3][4]. This phenomenon has been explained as the "loss of hemodynamic coherence, " and it emphasizes the need for expansion of macrocirculation-focused vital monitoring to encompass the microcirculation [5].…”

Section: Introductionmentioning

confidence: 99%

Feasibility study of incident dark-field video microscope for measuring microcirculatory variables in the mouse dorsal skinfold chamber model

et al. 2021

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Background Despite the importance of microcirculation in organ function, monitoring microcirculation is not a routine practice. With developments in microscopic technology, incident dark field (IDF) microscopy (Cytocam) has allowed visualization of the microcirculation. Dorsal skinfold chamber (DSC) mouse model has been used to investigate microcirculation physiology. By employing Cytocam-IDF imaging with DSC model to assess microcirculatory alteration in lipopolysaccharide (LPS)-induced endotoxemia, we attempted to validate availability of Cytocam-IDF imaging of microcirculation. Methods DSC was implanted in eight BALB/c mice for each group; control and sepsis. Both groups were given 72 hours to recover from surgery. The sepsis group had an additional 24-hour period of recovery post-LPS injection (4 mg/kg). Subsequently, a video of the microcirculation was recorded using Cytocam. Data on microcirculatory variables were obtained. Electron microscopy was implemented using lanthanum fixation to detect endothelial glycocalyx degradation. Results The microcirculatory flow index was significantly lower (control, 2.8±0.3; sepsis, 2.1±0.8; P=0.033) and heterogeneity index was considerably higher (control, 0.10±0.15; sepsis, 0.53±0.48; P=0.044) in the sepsis group than in the control group. Electron microscopy revealed glycocalyx demolishment in the sepsis group. Conclusions Cytocam showed reliable ability for observing changes in the microcirculation under septic conditions in the DSC model. The convenience and good imaging quality and the automatic analysis software available for Cytocam-IDF imaging, along with the ability to perform real-time in vivo experiments in the DSC model, are expected to be helpful in future microcirculation investigations.

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The response of the microcirculation to mechanical support of the heart in critical illness

Cited by 7 publications

References 43 publications

Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy

Feasibility study of incident dark-field video microscope for measuring microcirculatory variables in the mouse dorsal skinfold chamber model

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