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Observational Study
. 2018 Aug 19;22(1):200.
doi: 10.1186/s13054-018-2081-2.

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

Yu-Chang Yeh  1 , Chen-Tse Lee  1 , Chih-Hsien Wang  2 , Yu-Kang Tu  3 , Chien-Heng Lai  2 , Yin-Chin Wang  1 , Anne Chao  1 , Chi-Hsiang Huang  1 , Ya-Jung Cheng  4 , Yih-Sharng Chen  5 ; NTUH Center of Microcirculation Medical Research (NCMMR)
Affiliations
Observational Study

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

Yu-Chang Yeh et al. Crit Care. .

Abstract

Background: Microcirculatory dysfunction develops in both septic and cardiogenic shock patients, and it is associated with poor prognosis in patients with septic shock. Information on the association between microcirculatory dysfunction and prognosis in cardiogenic shock patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is limited.

Methods: Sublingual microcirculation images were recorded using an incident dark-field video microscope at the following time points: within 12 h (T1), 24 h (T2), 48 h (T3), 72 h (T4), and 96 h (T5) after VA-ECMO placement. If a patient could be weaned off VA-ECMO, sublingual microcirculation images were recorded before and after VA-ECMO removal. Microcirculatory parameters were compared between 28-day nonsurvivors and survivors with VA-ECMO support. In addition, the microcirculation and clinical parameters were assessed as prognostic tests of 28-day mortality, and patients were divided into three subgroups according to microcirculation parameters for survival analysis.

Results: Forty-eight patients were enrolled in this study. At T1, the observed heart rate, mean arterial pressure, inotropic score and lactate level of 28-day nonsurvivors and survivors did not differ significantly, but the perfused small vessel density (PSVD) and proportion of perfused vessels (PPV) were lower in the 28-day nonsurvivors than in the survivors. The PSVD and PPV were slightly superior to lactate levels in predicting 28-day mortality (area under curve of 0.68, 0.70, and 0.62, respectively). The subgroup with the lowest PSVD (< 15 mm/mm2) and PPV (< 64%) values exhibited less favorable survival compared with the other two subgroups.

Conclusions: Early microcirculatory parameters could be used to predict the survival of cardiogenic shock patients with VA-ECMO support.

Trial registration: ClinicalTrials.gov, NCT02393274 . Registered on 19 March 2015.

Keywords: Cardiogenic shock; Extracorporeal membrane oxygenation; Microcirculation; Survival.

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Conflict of interest statement

Ethics approval and consent to participate

This prospective observational study was approved by the Research Ethics Committee of National Taiwan University Hospital (approval number 201412045RINA).

Consent for publication

Informed consent of the patients was obtained from their legally authorized representatives before enrollment in the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort flow chart of enrollment characteristics of patients receiving venoarterial extracorporeal membrane oxygenation life support (VA-ECMO). ECMO extracorporeal membrane oxygenation
Fig. 2
Fig. 2
Mean arterial pressure (MAP), inotropic score, lactate level, and microcirculation parameters of 28-day survivors and nonsurvivors after placement of venoarterial extracorporeal membrane oxygenation life support (VA-ECMO). The time points after placement of VA-ECOM are presented as T1 (within 12 h), T2 (24 h), T3 (48 h), T4 (72 h), and T5 (96 h). *p < 0.05 between 28-day survivors and nonsurvivors. MFI microvascular flow index, PPV proportion of perfused vessels, PSVD perfused small vessel density
Fig. 3
Fig. 3
Mean arterial pressure (MAP), inotropic score, lactate level, and microcirculation parameters of 28-day survivors and nonsurvivors before and after removal of venoarterial extracorporeal membrane oxygenation life support (VA-ECMO). The time point before removal of VA-ECOM is presented as R0, and the time points after removal of VA-ECOM are presented as R1 (6 h), R2 (24 h), R3 (48 h), and R4 (72 h). *p < 0.05 between 28-day survivors and nonsurvivors. MFI microvascular flow index, PPV proportion of perfused vessels, PSVD perfused small vessel density
Fig. 4
Fig. 4
Prognostic tests of 28-day mortality. APACHE Acute Physiology and Chronic Health Evaluation, AUC area under the curve, CI confidence interval, PPV proportion of perfused vessels, PSVD perfused small vessel density
Fig. 5
Fig. 5
Twenty-eight-day survival curves based on subgrouping by perfused small vessel density (PSVD) and proportion of perfused vessels (PPV). Patients were divided into three subgroups according to the 25th and 75th percentiles of a PSVD (mm/mm2) and b PPV (%) values
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References

    1. Aissaoui N, Luyt CE, Leprince P, Trouillet JL, Leger P, Pavie A, Diebold B, Chastre J, Combes A. Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med. 2011;37(11):1738–1745. doi: 10.1007/s00134-011-2358-2. - DOI - PubMed
    1. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372(9638):554–561. doi: 10.1016/S0140-6736(08)60958-7. - DOI - PubMed
    1. Schwarz B, Mair P, Margreiter J, Pomaroli A, Hoermann C, Bonatti J, Lindner KH. Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support. Crit Care Med. 2003;31(3):758–764. doi: 10.1097/01.CCM.0000053522.55711.E3. - DOI - PubMed
    1. Chen YS, Chao A, Yu HY, Ko WJ, Wu IH, Chen RJ, Huang SC, Lin FY, Wang SS. Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol. 2003;41(2):197–203. doi: 10.1016/S0735-1097(02)02716-X. - DOI - PubMed
    1. Yeh YC, Wang MJ, Chao A, Ko WJ, Chan WS, Fan SZ, Tsai JC, Sun WZ. Correlation between early sublingual small vessel density and late blood lactate level in critically ill surgical patients. J Surg Res. 2013;180(2):317–321. doi: 10.1016/j.jss.2012.05.006. - DOI - PubMed

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