Impact of preoperative extracorporeal membrane oxygenation on vasoactive inotrope score after implantation of left ventricular assist device

Abstract

The purpose of this study was to elucidate the difference in inotrope use between patients who underwent left ventricular assist device (LVAD) implantation with preoperative extracorporeal membrane oxygenation (ECMO) and those who underwent LVAD implantation without preoperative ECMO. One hundred and eight patients who underwent LVAD implantation were enrolled in this study. Prior to LVAD implantation, 27 patients received ECMO support (ECMO group) and the other 81 patients did not (non-ECMO group). Cardiac index (CI), mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), and the vasoactive inotropic score (VIS) were recorded at weaning from cardiopulmonary bypass (CPB), 30 min after weaning from CPB (min after CPB), 60 min after CPB, and at the end of surgery. MAP and VIS were also recorded before induction of anesthesia (baseline). The modified VIS was defined as: (dopamine µg/kg/min × 1 + dobutamine µg/kg/min × 1 + epinephrine µg/kg/min × 100 + noradrenaline µg/kg/min × 100 + milrinone µg/kg/min × 10 + olprinone µg/kg/min × 25). There were no significant differences between the ECMO group and the non-ECMO group in terms of hemodynamic parameters such as MAP, CI, and SvO2. However, the ECMO group had higher VIS and noradrenaline doses than that of non-ECMO group (p = 0.030 and p = 0.044, respectively). VIS was significantly higher in ECMO group at 30 min after CPB (p = 0.03), 60 min after CPB (p = 0.003), and at the end of the surgery (p < 0.001). The doses of noradrenaline were significantly higher in ECMO group at 60 min after CPB (p = 0.013), and at the end of surgery (p = 0.002). Patients who received ECMO support prior to LVAD implantation required significantly more noradrenaline to maintain normal levels of hemodynamic parameters compared with patients without ECMO.

Keywords: Inotrope score; Systemic inflammatory response; Vasopressor; Ventricular assist device.

Fig. 1

Change in vasoactive inotrope score during left ventricular assist device implantation in patients who received extracorporeal membrane oxygenation (ECMO) compared with those who did not. All data are expressed as mean (filled symbols) ± SD (bars). The filled circles and solid line represents the non-ECMO group, and the filled triangles and dotted line represents the ECMO group. ECMO extracorporeal membrane oxygenation, CPB cardiopulmonary bypass. *p < 0.05, **p < 0.01, ***p < 0.001

Fig. 2

Change in noradrenaline dose required during left ventricular assist device implantation in patients who received extracorporeal membrane oxygenation (ECMO) compared with those who did not. All data are expressed as mean (filled symbols) ± SD (bars). The filled circles and solid line represents the non-ECMO group, and the filled triangles and dotted line represents the ECMO group. ECMO extracorporeal membrane oxygenation, NAD noradrenaline, CPB cardiopulmonary bypass. *p < 0.05, **p < 0.01