PMID- 27776535
OWN - NLM
STAT- MEDLINE
DCOM- 20180119
LR  - 20220408
IS  - 1466-609X (Electronic)
IS  - 1364-8535 (Print)
IS  - 1364-8535 (Linking)
VI  - 20
IP  - 1
DP  - 2016 Oct 25
TI  - Microcirculatory assessment of patients under VA-ECMO.
PG  - 344
LID - 344
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an 
      effective technique for providing emergency mechanical circulatory support for 
      patients with cardiogenic shock. VA-ECMO enables a rapid restoration of global 
      systemic organ perfusion, but it has not been found to always show a parallel 
      improvement in the microcirculation. We hypothesized in this study that the 
      response of the microcirculation to the initiation of VA-ECMO might identify 
      patients with increased chances of intensive care unit (ICU) survival. METHODS: 
      Twenty-four patients were included in this study. Sublingual microcirculation 
      measurements were performed using the CytoCam-IDF (incident dark field) imaging 
      device. Microcirculatory measurements were performed at baseline, after VA-ECMO 
      insertion (T1), 48-72 h after initiation of VA-ECMO (T2), 5-6 days after (T3), 
      9-10 days after (T4), and within 24 h of VA-ECMO removal. RESULTS: Of the 24 
      patients included in the study population, 15 survived and 9 died while on 
      VA-ECMO. There was no significant difference between the systemic global 
      hemodynamic variables at initiation of VA-ECMO between the survivors and 
      non-survivors. There was, however, a significant difference in the 
      microcirculatory parameters of both small and large vessels at all time points 
      between the survivors and non-survivors. Perfused vessel density (PVD) at 
      baseline (survivor versus non-survivor, 19.21 versus 13.78 mm/mm(2), p = 0.001) 
      was able to predict ICU survival on initiation of VA-ECMO; the area under the 
      receiver operating characteristic curve (ROC) was 0.908 (95 % confidence interval 
      0.772-1.0). CONCLUSION: PVD of the sublingual microcirculation at initiation of 
      VA-ECMO can be used to predict ICU mortality in patients with cardiogenic shock.
FAU - Kara, Atila
AU  - Kara A
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. 
      atila.kara@hacettepe.edu.tr.
AD  - Department of Intensive Care, Hacettepe University Faculty of Medicine, Ankara, 
      Turkey. atila.kara@hacettepe.edu.tr.
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      Room H-603 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. 
      atila.kara@hacettepe.edu.tr.
FAU - Akin, Sakir
AU  - Akin S
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
AD  - Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Dos Reis Miranda, Dinis
AU  - Dos Reis Miranda D
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Struijs, Ard
AU  - Struijs A
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Caliskan, Kadir
AU  - Caliskan K
AD  - Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - van Thiel, Robert J
AU  - van Thiel RJ
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Dubois, Eric A
AU  - Dubois EA
AD  - Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - de Wilde, Wouter
AU  - de Wilde W
AD  - Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center 
      Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Zijlstra, Felix
AU  - Zijlstra F
AD  - Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Gommers, Diederik
AU  - Gommers D
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
FAU - Ince, Can
AU  - Ince C
AD  - Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 
      's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20161025
PL  - England
TA  - Crit Care
JT  - Critical care (London, England)
JID - 9801902
SB  - IM
MH  - Adult
MH  - Aged
MH  - Extracorporeal Membrane Oxygenation/*mortality/trends
MH  - Female
MH  - Hospital Mortality/*trends
MH  - Humans
MH  - Male
MH  - Microcirculation/*physiology
MH  - Middle Aged
MH  - Mouth Floor/blood supply
MH  - Shock, Cardiogenic/*mortality/physiopathology/*therapy
MH  - Survival Rate/trends
MH  - Young Adult
PMC - PMC5078964
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - ICU
OT  - Microcirculation
OT  - Survival
OT  - VA-ECMO
EDAT- 2016/10/26 06:00
MHDA- 2018/01/20 06:00
PMCR- 2016/10/25
CRDT- 2016/10/26 06:00
PHST- 2016/04/11 00:00 [received]
PHST- 2016/09/30 00:00 [accepted]
PHST- 2016/10/26 06:00 [pubmed]
PHST- 2018/01/20 06:00 [medline]
PHST- 2016/10/26 06:00 [entrez]
PHST- 2016/10/25 00:00 [pmc-release]
AID - 10.1186/s13054-016-1519-7 [pii]
AID - 1519 [pii]
AID - 10.1186/s13054-016-1519-7 [doi]
PST - epublish
SO  - Crit Care. 2016 Oct 25;20(1):344. doi: 10.1186/s13054-016-1519-7.