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Objective:To explore the impact factors of the outcome of venous-arterial extracorporeal membrane oxygenation (V-A ECMO) in patients with cardiogenic shock. Methods: Totally 37 cardiogenic shock patients who received V-A ECMO support were retrospectively analyzed. The patients were divided into tolerance group and intolerance group according to results of tolerance tests, and those in tolerance group were then divided into successful weaning subgroup (weaning and survival within 30 days) and failed weaning subgroup. The baseline data of patients in tolerance group and intolerance group were compared. The hemodynamic parameters measured with echocardiography were compared between successful weaning subgroup and failed weaning subgroup at the lowest flow during the weaning trial. Results: There were 32 patients in tolerance group and 5 in intolerance group. Among tolerance group, there were 22 cases in successful weaning subgroup and 7 in failed weaning subgroup,while 3 patients died within 30 days. Age (P=0.04) and bleeding rate (P0.05). During the weaning trial, venous oxygen saturation (SvO2), left ventricular outflow tract velocity-time integral (LVOT-VTI), left ventricular ejection fraction (LVEF) and mitral annulus lateral wall systolic velocity (Sa) of successful weaning subgroup were all higher than those of failed weaning subgroup (all P<0.05). Conclusion: SvO2, LVOT-VTI, LVEF and Sa were the impcat factors of outcome of V-A ECMO in patients with cardiogenic shock.
ABSTRACT
Objective To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n =20) and no weaning group (n =8).The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.Results Age,the peak of creatine kinase-MB levels(CK-MB),cardiac troponin Ⅰ levels (cTnⅠ),and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR =0.064,95％CI:0.008-0.527,P =0.011;OR =1.004,95％CI:1.002-1.108,P =0.039;OR =3.635,95％CI:1.320-9.740,P =0.020;OR =1.075,95％CI:1.045-1.286,P =0.013).In the weaning group,compared with pre-ECMO,mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2)were significantly increased at maximum flow on the first day during ECMO (all P ＜0.05),while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P ＜0.05).The values of MAP,StO2,left ventricular ejection fraction (LVEF),velocity-time integral of left ventricular outflow tract (LVOT-VTI),velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P＜0.05).Compared with the no weaning group,MAP,StO2,LVEF,LVO-TVTI and LatSa increased significantly in the weaning group (all P ＜0.05),and the left ventricular end diastolic volume (LVEDV)decreased obviously after ECMO weaning(P ＜0.05).Conclusions Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.
ABSTRACT
Objective@#To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).@*Methods@#A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.@*Results@#Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05).@*Conclusions@#Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.