What Is the Optimal Blood Pressure on Veno-Arterial Extracorporeal Membrane Oxygenation? Impact of Mean Arterial Pressure on Survival

Abstract

Blood pressure management is crucial for patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Lower pressure can lead to end-organ malperfusion, whereas higher pressure may compete with ECMO flow and cardiac output. The impact of mean arterial pressure (MAP) on outcomes of patients on VA ECMO was evaluated. Patients who were supported on VA ECMO from September 2010 to March 2016 were retrospectively analyzed for average MAP throughout their course on ECMO, excluding the first and last day. Survival and complications observed during ECMO were investigated by classifying patients into groups based on their average MAP. A total of 116 patients were identified. Average MAP was significantly higher in patients who survived to discharge (82 ± 5.6 vs. 78 ± 5.5 mm Hg, p = 0.0003). There was a positive association between MAP and survival. Survival was best with MAP higher than 90 mm Hg (71%) and worst with MAP less than 70 mm Hg, where no patient survived. MAP was an independent predictor of survival to discharge by multivariate analysis (odds ratio 1.17, p = 0.013). Vasopressors were used more frequently in patients with lower pressure (coefficient -3.14, p = 0.005) without affecting survival (odds ratio 0.95, p = 0.95). Although the MAP did not affect the probability of strokes or bleeding complications, patients with a higher MAP had a lower incidence of kidney injury (p = 0.007). In conclusion, survival of patients on VA ECMO was significantly greater with a higher MAP, without being affected by prolonged vasopressor use.

Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation

“…[1][2][3]10,11 In terms of maintaining adequate systemic perfusion and pressures, a larger arterial cannula is theoretically superior to obtain a higher flow and to avoid a high pressure gradient across the arterial cannula. 12 In this study, a median size of arterial cannula was 20 Fr (6.7 mm) that is comparable or even larger than those of previous studies (13.5-15 Fr, 1 15-17 Fr, 10,13 and 18 Fr 11 ). The average inner diameter of the common femoral artery has been reported as a 6.6 mm (3.9-8.9 mm) by angiography; 14 9.8 (male) and 8.2 mm (female) by vascular ultrasound.…”

“…1–3,10,11 In terms of maintaining adequate systemic perfusion and pressures, a larger arterial cannula is theoretically superior to obtain a higher flow and to avoid a high pressure gradient across the arterial cannula. 12…”

Achieving sustained extrauterine life: Challenges of an artificial placenta in fetal pigs as a model of the preterm human fetus

“…Importantly, extremely preterm human fetuses during their canalicular phase of lung development are 500–750 g (Kiserud et al, 2018), while the smallest sheep used in AP studies are twice that size (~1.0 kg) (Arens et al, 2011; Church, Coughlin, et al, 2018; Church, Perkins, et al, 2018; Church, Werner, et al, 2018; El‐Sabbagh et al, 2018; Gray et al, 2013; Hornick et al, 2018; Lawrence et al, 2018; Miura et al, 2012, 2015, 2016; Partridge, Davey, Hornick, McGovern, et al, 2017; Reoma et al, 2009; Rochow et al, 2013; Schoberer et al, 2014; Usuda et al, 2017; Westin et al, 1958; Zapol et al, 1969). Fetal size is associated with hemodynamic factors such as umbilical vessel caliber and blood pressure that are important for ECMO support (Rafat & Schaible, 2019; Tanaka et al, 2019). Furthermore, the vascular anatomy of the sheep umbilical cord is different from that of humans, with sheep having two umbilical arteries and two umbilical veins in contrast to human fetuses that have only one umbilical vein (UV) (Benirschke & Kaufmann, 2000; Steven, 1968).…”

Comparing in-patient extracorporeal cardiopulmonary resuscitation to standard cardiac treatment group of extracorporeal membrane oxygenation patients: 8 years of experience at a single institution

“…As mentioned previously, even in E-CPR, there was always an attempt to place DPC in all patients. 13 If the team was not able to achieve DPC during E-CPR, it was placed in either the ICU or by the on-call vascular surgeon via surgical cut-down. This protocol minimizes technically correctable complications and may contribute to the acceptable incidence of leg ischemia and renal complications in this study.…”