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Echocardiographic predictors of 30-day survival after veno-arterial extracorporeal membrane oxygenation in refractory cardiogenic shock / 中华超声影像学杂志
Chinese Journal of Ultrasonography ; (12): 829-835, 2021.
Article in Chinese | WPRIM | ID: wpr-910126
ABSTRACT

Objective:

To investigate the predictive value of echocardiography hemodynamic parameters on 30-day survival rate after veno-arterial extracorporeal membrane oxygenation in refractory cardiogenic shock.

Methods:

A total of 44 patients with refractory cardiogenic shock who passed VA-ECMO weaning trial were retrospectively analyzed from September 2014 to February 2021. According to their 30-day survival outcomes after VA-ECMO removal, these patients were divided into the survival group (32 cases) and the death group (12 cases). Baseline data and the change rate of echocardiographic parameters between the first day of VA-ECMO and the day on VA-ECMO removal were compared, and the ultrasonic indicators affecting the survival of VA-ECMO within 30 days after withdrawal were determined.

Results:

The change rate of left ventricular ejection fraction(&Delta;LVEF%), the change rate of velocity time integral of the left ventricular outflow tract(&Delta;LVOT-VTI%), the change rate of &Delta;Sa% and the change rate of right ventricular fractional area change(&Delta;RVFAC%) were improved significantly in the survival group ( P<0.05). The correlation coefficients between &Delta;LVEF% and &Delta;LVOT-VTI%, &Delta;LVEF% and &Delta;Sa%, &Delta;LVEF % and &Delta;RVFAC% were 0.885, 0.861, 0.675, respectively( P<0.001); The correlation coefficient between &Delta;LVOT-VTI% and &Delta;Sa was 0.918( P<0.001). ROC curve showed that the cut off values of &Delta;LVEF%, &Delta;LVOT-VTI%, &Delta;Sa% and &Delta;RVFAC% to predict 30-day survival rate were 23.6%, 20.1%, 22.8% and 23.2% respectively, the sensitivity was 89.5%, 93%, 89.5% and 74.6% respectively, specificity was 66.7%, 66.7%, 66.8% and 75% respectively, the area under ROC curve (AUC) was 0.841, 0.867, 0.841 and 0.768, respectively.

Conclusions:

&Delta;LVEF%, &Delta;LVOT-VTI%, &Delta;Sa% and &Delta;RVFAC% are predictive indicators of VA-ECMO withdrawl in patients with refractory cardiac shock. &Delta;LVOT-VTI% is the most valuable indicator of predicting 30-day survival rate after VA-ECMO withdrawl. Patients who meet two or more VA-ECMO echocardiographic indicators are more likely to succeed in VA-ECMO withdrawl. The improvement of right ventricular systolic function is a prerequisite for survival after 30 days of VA-ECMO withdrawal, while LVEF is an important criterion for survival after 30 days of VA-ECMO withdrawal.

Full text: Available Index: WPRIM (Western Pacific) Type of study: Prognostic study Language: Chinese Journal: Chinese Journal of Ultrasonography Year: 2021 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Type of study: Prognostic study Language: Chinese Journal: Chinese Journal of Ultrasonography Year: 2021 Type: Article