PMID- 37002046
OWN - NLM
STAT- MEDLINE
DCOM- 20230907
LR  - 20230907
IS  - 0219-3108 (Electronic)
IS  - 1015-9584 (Linking)
VI  - 46
IP  - 9
DP  - 2023 Sep
TI  - Prognostic effects of microcirculation-assisted adjustment of venoarterial blood 
      flow in extracorporeal membrane oxygenation: A prospective, pilot, randomized 
      controlled trial.
PG  - 3549-3554
LID - S1015-9584(23)00376-7 [pii]
LID - 10.1016/j.asjsur.2023.03.069 [doi]
AB  - OBJECTIVE: The study explored the clinical efficacy of microcirculation-assisted 
      blood flow adjustment in patients receiving venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO). METHODS: This prospective, pilot, randomized controlled 
      trial was conducted from 2018 to 2021; enrolled patients were randomly assigned 
      to the microcirculation or control group at a 1:1 ratio. Microcirculatory and 
      clinical data were collected within 24 h (T1) and at 24-48 h (T2), 48-72 h (T3), 
      and 72-96 h (T4) after ECMO initiation and were compared between the groups 
      following the intention-to-treat (ITT) principle. The primary outcome was the 
      Sequential Organ Failure Assessment (SOFA) score at T2. In addition to ITT 
      analysis, analysis based on the as-treated (AT) principle was performed. RESULTS: 
      A total of 35 patients were enrolled in this study. At T2, the SOFA score did not 
      significantly differ between the microcirculation and control groups (16 
      [14.8-17] vs. 16 [12.5-18], P = 0.782). Generalized estimating equation analysis 
      demonstrated a significantly greater reduction in the SOFA score over time in the 
      microcirculation-AT group than in the control-AT group (estimated 
      difference: -0.767, standard error: 0.327, P = 0.019). The lactate level at T2 
      was significantly lower in the microcirculation-AT group (2.7 [2.0-3.6] vs. 4.1 
      [3.0-6.6] mmol/L, P = 0.029). No significant difference in the 30-day survival 
      rate was noted between the groups. CONCLUSION: This prospective pilot study 
      demonstrated the feasibility of microcirculation-assisted VA-ECMO blood flow 
      adjustment despite no significant clinical benefit for critically ill patients. 
      More efforts in personnel training and newer technologies may help achieve 
      microcirculation optimization.
CI  - Copyright (c) 2023 Asian Surgical Association and Taiwan Robotic Surgery 
      Association. Published by Elsevier B.V. All rights reserved.
FAU - Chen, Ping-Ju
AU  - Chen PJ
AD  - Department of Anesthesiology, National Taiwan University Hospital, Taipei, 
      Taiwan.
FAU - Yeh, Yu-Chang
AU  - Yeh YC
AD  - Department of Anesthesiology, National Taiwan University Hospital, Taipei, 
      Taiwan.
FAU - Huang, Chi-Hsiang
AU  - Huang CH
AD  - Department of Anesthesiology, National Taiwan University Hospital, Taipei, 
      Taiwan.
FAU - Wei, Tzu-Jung
AU  - Wei TJ
AD  - Department of Anesthesiology, National Taiwan University Hospital, Taipei, 
      Taiwan.
FAU - Lai, Chien-Heng
AU  - Lai CH
AD  - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Yang, Yun-Ping
AU  - Yang YP
AD  - Department of Anesthesiology, National Taiwan University Hospital, Taipei, 
      Taiwan.
FAU - Chen, Yih-Sharng
AU  - Chen YS
AD  - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Wang, Chih-Hsien
AU  - Wang CH
AD  - Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 
      Electronic address: wchemail@ntu.edu.tw.
FAU - Lee, Chen-Tse
AU  - Lee CT
AD  - Department of Anesthesiology, National Taiwan University Hospital, Taipei, 
      Taiwan. Electronic address: lctbrian314@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20230329
PL  - Netherlands
TA  - Asian J Surg
JT  - Asian journal of surgery
JID - 8900600
SB  - IM
MH  - Humans
MH  - Prognosis
MH  - Microcirculation/physiology
MH  - *Extracorporeal Membrane Oxygenation
MH  - Prospective Studies
MH  - Pilot Projects
OTO - NOTNLM
OT  - Critical care
OT  - Extracorporeal membrane oxygenation
OT  - Hemodynamics
OT  - Microcirculation
COIS- Declaration of competing interest The authors declare that they have no competing 
      interests.
EDAT- 2023/04/01 06:00
MHDA- 2023/09/07 06:42
CRDT- 2023/03/31 22:03
PHST- 2022/12/13 00:00 [received]
PHST- 2023/02/03 00:00 [revised]
PHST- 2023/03/15 00:00 [accepted]
PHST- 2023/09/07 06:42 [medline]
PHST- 2023/04/01 06:00 [pubmed]
PHST- 2023/03/31 22:03 [entrez]
AID - S1015-9584(23)00376-7 [pii]
AID - 10.1016/j.asjsur.2023.03.069 [doi]
PST - ppublish
SO  - Asian J Surg. 2023 Sep;46(9):3549-3554. doi: 10.1016/j.asjsur.2023.03.069. Epub 
      2023 Mar 29.