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

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 extracorporea...

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Published in:Critical care (London, England) England), 2018-08, Vol.22 (1), p.200-200, Article 200
Main Authors: Yeh, Yu-Chang, Lee, Chen-Tse, Wang, Chih-Hsien, Tu, Yu-Kang, Lai, Chien-Heng, Wang, Yin-Chin, Chao, Anne, Huang, Chi-Hsiang, Cheng, Ya-Jung, Chen, Yih-Sharng
Format: Article
Language:English
Subjects:
Blood circulation
Cardiac patients
Cardiogenic shock
Critical care
Extracorporeal membrane oxygenation
Health aspects
Heart failure
Heart rate
Intensive care
Medical prognosis
Microcirculation
Microcirculation disorders
Mortality
Patients
Prognosis
Respiratory therapy
Risk factors
Sepsis
Survival
Survival analysis
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Summary: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. 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. 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 (
ISSN:1364-8535
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-018-2081-2