Assessment of cardiac load-responsiveness in veno-arterial extracorporeal life support: A case series.

Autor:	Cornelisse Y; Department of Extra-Corporeal Circulation and Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands., Weerwind PW; Department of Extra-Corporeal Circulation and Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands., Bol ME; Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.; School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands., Simons AP; Advanced Extracorporeal Therapies - perfusion services, training & education, Landgraaf, the Netherlands.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2024 Sep; Vol. 39 (6), pp. 1174-1178. Date of Electronic Publication: 2023 Jun 06.
DOI:	10.1177/02676591231181463
Abstrakt:	Introduction: Well-timed explant of veno-arterial extracorporeal life support (V-A ECLS) depends on adequate assessment of cardiac recovery. Often, evaluation of cardiac recovery consists of reducing support flow while visualizing cardiac response using transoesophageal echocardiography (TEE). This method, however, is time consuming and based on subjective findings. The dynamic filling index (DFI) may aid in the quantitative assessment of cardiac load-responsiveness. The dynamic filling index is based on the relationship of support flow and pump speed, which varies with varying hemodynamic conditions. This case series intends to investigate whether the DFI may support TEE in facilitating the assessment of cardiac load-responsiveness. Methods: Measurements for DFI-determination were performed in seven patients while simultaneously assessing ventricular function by measuring the aortic velocity time integral (VTI) using TEE. Measurements consisted of multiple consecutive transient speed manipulations (∼100 r/min) during weaning trials, both at full support and during cardiac reloading at reduced support. Results: The VTI increased between full and reduced support in six weaning trials. In five of these trials DFI decreased or remained equal, and in one case DFI increased. Of the three trials in which VTI decreased between full and reduced support, DFI increased in two cases and decreased in one case. Changes in DFI, however, are mostly smaller than the detection threshold of 0.4 mL/rotation. Conclusion: Even though current level of accuracy of the parameter requires further investigation to increase reliability and possibly predictability, DFI seems likely to be a potential parameter in supporting TEE for the assessment of cardiac load-responsiveness. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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