Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock

Autor: Matej Hrachovina, Mikulas Mlcek, Otomar Kittnar, Martin Ostadal, Holger Gorhan, James C. Leiter, Andreas J. Krüger, Dagmar Vondrakova, Pavel Hala, Ivo Simundic, Petr Neuzil, Svitlana Strunina, Marek Janotka, Petr Ostadal, Martin Mates
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Cardiac output
Physiology
Swine
Pulsatile flow
lcsh:Medicine
Blood Pressure
030204 cardiovascular system & hematology
Vascular Medicine
Ventricular Function
Left
Electrocardiography
0302 clinical medicine
Pig Models
Blood Flow
Medicine and Health Sciences
lcsh:Science
Flow Rate
Multidisciplinary
Ejection fraction
Cardiogenic shock
Physics
Classical Mechanics
Heart
Animal Models
Hematology
Coronary Vessels
Body Fluids
medicine.anatomical_structure
Blood
Experimental Organism Systems
Shock (circulatory)
Pulsatile Flow
Physical Sciences
Cardiology
Female
medicine.symptom
Anatomy
Research Article
Biotechnology
medicine.medical_specialty
Mean arterial pressure
endocrine system
Catheters
Cardiac Ventricles
Shock
Cardiogenic
Fluid Mechanics
Research and Analysis Methods
Continuum Mechanics
03 medical and health sciences
Coronary circulation
Extracorporeal Membrane Oxygenation
Afterload
Internal medicine
Coronary Circulation
medicine
Animals
business.industry
lcsh:R
Hemodynamics
Biology and Life Sciences
Fluid Dynamics
medicine.disease
Life Support Care
Disease Models
Animal
030228 respiratory system
Cardiovascular Anatomy
Medical Devices and Equipment
lcsh:Q
business
Zdroj: PLoS ONE, Vol 13, Iss 4, p e0196321 (2018)
PLoS ONE
ISSN: 1932-6203
Popis: Introduction Veno-arterial extracorporeal life support (ECLS) is increasingly being used to treat rapidly progressing or severe cardiogenic shock. However, it has been repeatedly shown that increased afterload associated with ECLS significantly diminishes left ventricular (LV) performance. The objective of the present study was to compare LV function and coronary flow during standard continuous-flow ECLS support and electrocardiogram (ECG)-synchronized pulsatile ECLS flow in a porcine model of cardiogenic shock. Methods Sixteen female swine (mean body weight 45 kg) underwent ECLS implantation under general anesthesia and artificial ventilation. Subsequently, acute cardiogenic shock, with documented signs of tissue hypoperfusion, was induced by initiating global myocardial hypoxia. Hemodynamic cardiac performance variables and coronary flow were then measured at different rates of continuous or pulsatile ECLS flow (ranging from 1 L/min to 4 L/min) using arterial and venous catheters, a pulmonary artery catheter, an LV pressure-volume loop catheter, and a Doppler coronary guide-wire. Results Myocardial hypoxia resulted in declines in mean cardiac output to 1.7±0.7 L/min, systolic blood pressure to 64±22 mmHg, and LV ejection fraction (LVEF) to 22±7%. Synchronized pulsatile flow was associated with a significant reduction in LV end-systolic volume by 6.2 mL (6.7%), an increase in LV stroke volume by 5.0 mL (17.4%), higher LVEF by 4.5% (18.8% relative), cardiac output by 0.37 L/min (17.1%), and mean arterial pressure by 3.0 mmHg (5.5%) when compared with continuous ECLS flow at all ECLS flow rates (P
Databáze: OpenAIRE
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