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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Microcirculatory assessment of patients under VA-ECMO

Authors: Atila Kara, Sakir Akin, Dinis dos Reis Miranda, Ard Struijs, Kadir Caliskan, Robert J. van Thiel, Eric A. Dubois, Wouter de Wilde, Felix Zijlstra, Diederik Gommers, Can Ince

Published in: Critical Care | Issue 1/2016

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Abstract

Background

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.

Methods

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.

Results

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/mm2, 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).

Conclusion

PVD of the sublingual microcirculation at initiation of VA-ECMO can be used to predict ICU mortality in patients with cardiogenic shock.
Appendix
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Metadata
Title
Microcirculatory assessment of patients under VA-ECMO
Authors
Atila Kara
Sakir Akin
Dinis dos Reis Miranda
Ard Struijs
Kadir Caliskan
Robert J. van Thiel
Eric A. Dubois
Wouter de Wilde
Felix Zijlstra
Diederik Gommers
Can Ince
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1519-7

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