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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

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

Authors: Yu-Chang Yeh, Chen-Tse Lee, Chih-Hsien Wang, Yu-Kang Tu, Chien-Heng Lai, Yin-Chin Wang, Anne Chao, Chi-Hsiang Huang, Ya-Jung Cheng, Yih-Sharng Chen, on behalf of the NTUH Center of Microcirculation Medical Research (NCMMR)

Published in: Critical Care | Issue 1/2018

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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.
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Metadata
Title
Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
Authors
Yu-Chang Yeh
Chen-Tse Lee
Chih-Hsien Wang
Yu-Kang Tu
Chien-Heng Lai
Yin-Chin Wang
Anne Chao
Chi-Hsiang Huang
Ya-Jung Cheng
Yih-Sharng Chen
on behalf of the NTUH Center of Microcirculation Medical Research (NCMMR)
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2081-2

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