| Autor: |
Ng, Pauline Yeung, Ma, Sin Kwan Tammy, Ip, April, Fang, Shu, Wong, Alfred Sai Kuen, Ngai, Chun Wai, Chan, Wai Ming, Sin, Wai Ching |
| Zdroj: |
Circulation (Ovid); November 2021, Vol. 144 Issue: Supplement 1 pA10117-A10117, 1p |
| Abstrakt: |
Introduction:Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) poses increased afterload to the injured heart. The reactivity of myocardial contractility to ECMO blood flow during various phases of acute myocardial dysfunction has not been examined.Hypothesis:We hypothesized that myocardial contractility is more reactive to the afterload effects of peripheral V-A ECMO during the acute stage of myocardial dysfunction.Methods:Adult patients who were supported by peripheral V-A ECMO between April 2019 and October 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by TTE within 48 hours after initiation of V-A ECMO (“acute phase”) and upon weaning (“delayed phase”). Measurements were obtained at 100%, 120%, and 50% of ECMO target blood flow.Results:A total of 30 patients were included, 22 (71%) were male, and the mean±SD age was 54±13 years. The main indications of ECMO were myocardial infarction (19 patients, 63%) and myocarditis (5, 17%). TTE was performed on a median of day 1 (1-1) (n=30, “acute phase”) and day 4.5 (3-6) (n=24, “delayed phase”) after initiation of ECMO. Left ventricular contractility was reactive to afterload effects from V-A ECMO in both the acute and delayed phases, with an improvement in LVEF during ECMO flow reduction from 21.5 to 30.9% (p<0.001) and 34.5 to 41.7% (p=0.002), respectively. The change in LVEF was similar in the acute phase compared with the delayed phase when considering the whole cohort [median (IQR) change in LVEF: 8.88 (5.26 - 13.7)% vs 6.12 (0.64 - 15.60)%, p=0.38]. Of the 24 patients who had a TTE during the delayed phase, 16 (66.7%) had myocardial recovery and were weanable from ECMO support. The reactivity of LVEF to ECMO blood flow was similar in the patients who were weanable compared with patients who were not weanable [median (IQR) change in LVEF: 10.21 (2.61 - 16.21)% vs 3.20 (-2.13 - 6.79)%, p=0.14].Conclusions:In conclusion, we demonstrated that the reactivity of left ventricular contractility to afterload effects of V-A ECMO was not significantly different at different stages of acute myocardial dysfunction. Future studies should examine the predictive value and clinical utility of these echocardiographic measurements in patients on V-A ECMO. |
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