Microcirculatory assessment of patients under VA-ECMO

• Published in: Critical care (London, England) Vol. 20; no. 1; p. 344
• Main Authors: Kara, Atila, Akin, Sakir, Dos Reis Miranda, Dinis, Struijs, Ard, Caliskan, Kadir, van Thiel, Robert J, Dubois, Eric A, de Wilde, Wouter, Zijlstra, Felix, Gommers, Diederik, Ince, Can
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.10.2016; BioMed Central
• Subjects: Adult; Aged; Analysis; Cardiogenic shock; Causes of; Complications and side effects; Critical care; Extracorporeal Membrane Oxygenation - mortality; Extracorporeal Membrane Oxygenation - trends; Female; Heart failure; Hospital Mortality - trends; Humans; Male; Microcirculation; Microcirculation - physiology; Middle Aged; Mouth Floor - blood supply; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Survival Rate - trends; Young Adult; Taiwan; Microcirculation; ICU; Survival; Cardiogenic shock; VA-ECMO
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-016-1519-7

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective technique for providing emergency mechanical circulatory support for patients with cardiogenic shock. VA-ECMO enables a rapid restoration of global systemic organ perfusion, but it has not been found to always show a parallel improvement in the microcirculation. We hypothesized in this study that the response of the microcirculation to the initiation of VA-ECMO might identify patients with increased chances of intensive care unit (ICU) survival. Twenty-four patients were included in this study. Sublingual microcirculation measurements were performed using the CytoCam-IDF (incident dark field) imaging device. Microcirculatory measurements were performed at baseline, after VA-ECMO insertion (T1), 48-72 h after initiation of VA-ECMO (T2), 5-6 days after (T3), 9-10 days after (T4), and within 24 h of VA-ECMO removal. Of the 24 patients included in the study population, 15 survived and 9 died while on VA-ECMO. There was no significant difference between the systemic global hemodynamic variables at initiation of VA-ECMO between the survivors and non-survivors. There was, however, a significant difference in the microcirculatory parameters of both small and large vessels at all time points between the survivors and non-survivors. Perfused vessel density (PVD) at baseline (survivor versus non-survivor, 19.21 versus 13.78 mm/mm , p = 0.001) was able to predict ICU survival on initiation of VA-ECMO; the area under the receiver operating characteristic curve (ROC) was 0.908 (95 % confidence interval 0.772-1.0). PVD of the sublingual microcirculation at initiation of VA-ECMO can be used to predict ICU mortality in patients with cardiogenic shock.