Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock
Abstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculato...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-10-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-017-1855-2 |
| _version_ | 1818136280660180992 |
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| author | Sakir Akin Dinis dos Reis Miranda Kadir Caliskan Osama I. Soliman Goksel Guven Ard Struijs Robert J. van Thiel Lucia S. Jewbali Alexandre Lima Diederik Gommers Felix Zijlstra Can Ince |
| author_facet | Sakir Akin Dinis dos Reis Miranda Kadir Caliskan Osama I. Soliman Goksel Guven Ard Struijs Robert J. van Thiel Lucia S. Jewbali Alexandre Lima Diederik Gommers Felix Zijlstra Can Ince |
| author_sort | Sakir Akin |
| collection | DOAJ |
| description | Abstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters. Methods Weaning was performed by decreasing the VA-ECMO flow to 50% (F50) from the baseline. The endpoint of the study was successful VA-ECMO explantation within 48 hours after weaning. The response of sublingual microcirculation to a weaning attempt (WA) was evaluated. Microcirculation was measured in one sublingual area (single spot (ss)) using CytoCam IDF imaging during WA. Total vessel density (TVDss) and perfused vessel density (PVDss) of the sublingual area were evaluated before and during 50% flow reduction (TVDssF50, PVDssF50) after a WA and compared to conventional echocardiographic parameters as indicators of the success or failure of the WA. Results Patients (n = 13) aged 49 ± 18 years, who received VA-ECMO for the treatment of refractory CS due to pulmonary embolism (n = 5), post cardiotomy (n = 3), acute coronary syndrome (n = 2), myocarditis (n = 2) and drug intoxication (n = 1), were included. TVDssF50 (21.9 vs 12.9 mm/mm2, p = 0.001), PVDssF50 (19.7 vs 12.4 mm/mm2, p = 0.01) and aortic velocity–time integral (VTI) at 50% flow reduction (VTIF50) were higher in patients successfully weaned vs not successfully weaned. The area under the curve (AUC) was 0.99 vs 0.93 vs 0.85 for TVDssF50 (small vessels) >12.2 mm/mm2, left ventricular ejection fraction (LVEF) >15% and aortic VTI >11 cm. Likewise, the AUC was 0.91 vs 0.93 vs 0.85 for the PVDssF50 (all vessels) >14.8 mm/mm2, LVEF >15% and aortic VTI >11 cm. Conclusion This study identified sublingual microcirculation as a novel potential marker for identifying successful weaning from VA-ECMO. Sustained values of TVDssF50 and PVDssF50 were found to be specific and sensitive indicators of successful weaning from VA-ECMO as compared to echocardiographic parameters. |
| first_indexed | 2024-12-11T09:37:54Z |
| format | Article |
| id | doaj.art-1c4d84ffaadc442ca453a38ee969f6b6 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-11T09:37:54Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-1c4d84ffaadc442ca453a38ee969f6b62022-12-22T01:12:46ZengBMCCritical Care1364-85352017-10-012111910.1186/s13054-017-1855-2Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shockSakir Akin0Dinis dos Reis Miranda1Kadir Caliskan2Osama I. Soliman3Goksel Guven4Ard Struijs5Robert J. van Thiel6Lucia S. Jewbali7Alexandre Lima8Diederik Gommers9Felix Zijlstra10Can Ince11Department of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Cardiology, Erasmus MC, University Medical Center RotterdamDepartment of Cardiology, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamDepartment of Cardiology, Erasmus MC, University Medical Center RotterdamDepartment of Intensive Care, Erasmus MC, University Medical Center RotterdamAbstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters. Methods Weaning was performed by decreasing the VA-ECMO flow to 50% (F50) from the baseline. The endpoint of the study was successful VA-ECMO explantation within 48 hours after weaning. The response of sublingual microcirculation to a weaning attempt (WA) was evaluated. Microcirculation was measured in one sublingual area (single spot (ss)) using CytoCam IDF imaging during WA. Total vessel density (TVDss) and perfused vessel density (PVDss) of the sublingual area were evaluated before and during 50% flow reduction (TVDssF50, PVDssF50) after a WA and compared to conventional echocardiographic parameters as indicators of the success or failure of the WA. Results Patients (n = 13) aged 49 ± 18 years, who received VA-ECMO for the treatment of refractory CS due to pulmonary embolism (n = 5), post cardiotomy (n = 3), acute coronary syndrome (n = 2), myocarditis (n = 2) and drug intoxication (n = 1), were included. TVDssF50 (21.9 vs 12.9 mm/mm2, p = 0.001), PVDssF50 (19.7 vs 12.4 mm/mm2, p = 0.01) and aortic velocity–time integral (VTI) at 50% flow reduction (VTIF50) were higher in patients successfully weaned vs not successfully weaned. The area under the curve (AUC) was 0.99 vs 0.93 vs 0.85 for TVDssF50 (small vessels) >12.2 mm/mm2, left ventricular ejection fraction (LVEF) >15% and aortic VTI >11 cm. Likewise, the AUC was 0.91 vs 0.93 vs 0.85 for the PVDssF50 (all vessels) >14.8 mm/mm2, LVEF >15% and aortic VTI >11 cm. Conclusion This study identified sublingual microcirculation as a novel potential marker for identifying successful weaning from VA-ECMO. Sustained values of TVDssF50 and PVDssF50 were found to be specific and sensitive indicators of successful weaning from VA-ECMO as compared to echocardiographic parameters.http://link.springer.com/article/10.1186/s13054-017-1855-2Cardiogenic shockVA-ECMOMicrocirculationIncident dark field imagingSublingualCytoCam |
| spellingShingle | Sakir Akin Dinis dos Reis Miranda Kadir Caliskan Osama I. Soliman Goksel Guven Ard Struijs Robert J. van Thiel Lucia S. Jewbali Alexandre Lima Diederik Gommers Felix Zijlstra Can Ince Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock Critical Care Cardiogenic shock VA-ECMO Microcirculation Incident dark field imaging Sublingual CytoCam |
| title | Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock |
| title_full | Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock |
| title_fullStr | Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock |
| title_full_unstemmed | Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock |
| title_short | Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock |
| title_sort | functional evaluation of sublingual microcirculation indicates successful weaning from va ecmo in cardiogenic shock |
| topic | Cardiogenic shock VA-ECMO Microcirculation Incident dark field imaging Sublingual CytoCam |
| url | http://link.springer.com/article/10.1186/s13054-017-1855-2 |
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