Echocardiographic parameters for weaning from Extracorporeal Membrane Oxygenation - the role of longitudinal function and cardiac time intervals.

Autor:	Tavazzi G; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.; Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy., Colombo CNJ; Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy.; PhD in Experimental Medicine, University of Pavia, Via Ferrata 5, Pavia 27100, Italy., Klersy C; Unit of Clinical Epidemiology and Biostatistics, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy., Dammassa V; PhD in Experimental Medicine, University of Pavia, Via Ferrata 5, Pavia 27100, Italy.; Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom., Civardi L; Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy., Degani A; Department of Cardiothoracic Surgery Fondazione IRCCS Policlinico San Matteo Pavia., Biglia A; Department of Cardiothoracic Surgery Fondazione IRCCS Policlinico San Matteo Pavia., Via G; Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland., Camporotondo R; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy., Pellegrini C; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.; Department of Cardiothoracic Surgery Fondazione IRCCS Policlinico San Matteo Pavia., Price S; Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom.; National Heart and Lung Institute, Imperial College, London, UK.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2024 Oct 23. Date of Electronic Publication: 2024 Oct 23.
DOI:	10.1093/ehjci/jeae274
Abstrakt:	Aim: Limited data exist on echocardiographic predictors of weaning from veno-arterial extracorporeal membrane oxygenation (V-A ECMO). We aimed to test the performance of different echocardiographic indices to predict weaning from V-A ECMO. and free survival after weaning. Methods and Results: Observational study including patients with cardiogenic shock submitted to V-AECMO. Echocardiography was performed after V-AECMO placement and daily during the weaning trial to assess cardiac recovery. Echocardiography data after V-A ECMO implantation and during the last weaning-trial before V-A ECMO removal were analyzed. Besides traditional parameters, total isovolumic time (t-IVT, a left ventricular performance index) and mitral annular plane systolic excursion (MAPSE) were also tested.76 patients were included. A greater ventricular velocity-time integral (LVOT VTI) at baseline was associated with a 5-fold increase in weaning success (p < 0.001) as MAPSE lateral >6.15 mm (p 0.001) did. TAPSE and S' at tricuspid annulus showed an analogous association. During the weaning trial t-IVT, LVEF, MAPSE, LVOT VTI and TAPSE all improved significantly (p <0.001 for all). At regression analysis t-IVT <14.4second/minute (<0.001), LVOT VTI >12.3cm (p <0.001), MAPSE >8.9mm (p < 0.001), TAPSE> 16mm (<0.001) and E/e' <15.5 (p 0.001) were associated with weaning success and free survival after weaning. LVEF did not predict the weaning success and survival at any time-point (p 0.230). Conclusions: Longitudinal function, t-IVT and native ejection, measured with LVOT VTI, are reliable parameters to predict weaning success in V-A ECMO whereas the LVEF, although dynamically changing during weaning trial, it is not. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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