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

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 e...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098836/
https://www.ncbi.nlm.nih.gov/pubmed/30121090
http://dx.doi.org/10.1186/s13054-018-2081-2
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author 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
author_facet 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
author_sort Yeh, Yu-Chang
collection PubMed
description 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/mm(2)) 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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spelling pubmed-60988362018-08-23 Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support 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 Crit Care Research 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/mm(2)) 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. BioMed Central 2018-08-19 /pmc/articles/PMC6098836/ /pubmed/30121090 http://dx.doi.org/10.1186/s13054-018-2081-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
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
Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
title Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
title_full Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
title_fullStr Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
title_full_unstemmed Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
title_short Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
title_sort investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098836/
https://www.ncbi.nlm.nih.gov/pubmed/30121090
http://dx.doi.org/10.1186/s13054-018-2081-2
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