Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Akın, Şakir; Miranda, Dinís Dos Reis; Çalışkan, Kadir; Soliman, Osama Ibrahim Ibrahim; Güven, Göksel; Struijs, Ard; Thiel, Robert van; Jewbali, Lucia S.D.; Lima, Alexandre; Gommers, Diederik; Zijlstra, Felix; İnce, Can

doi:10.1186/s13054-017-1855-2

Cited by 62 publications

(49 citation statements)

References 40 publications

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“…Few studies aimed at identifying criteria to predict which patients can be successfully weaned from ECMO, using the same methodology ( Table 1) (13)(14)(15)(18)(19)(20). They assessed prospectively and daily clinical, biological and/or echo parameters until death, weaning or bridge to long-term assist-device or heart transplantation.…”

Section: Which Factors Can Help To Predict Successful Weaning From Vamentioning

confidence: 99%

“…Akin et al recently reported in a study on 13 patients that the assessment of the sublingual microcirculation functional parameters, such as the total vessel density and perfused vessel density, may be of worth alongside weaning from VA ECMO (19). Patients who were not weaned from VA ECMO had clear deterioration in total small and large vessel densities.…”

Section: Microcirculation Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ortuno¹,

Delmas²,

Diehl³

et al. 2019

Ann. Cardiothorac. Surg

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Refractory cardiogenic shock patients may be rescued by veno-arterial extracorporeal membrane oxygenation (VA ECMO). After a few days of mechanical assistance, the device can sometimes be successfully removed if the patient has partially or fully recovered from the condition that required the use of ECMO. The percentage of patients with refractory cardiogenic shock who are successfully weaned from ECMO varies from 31% to 76%. Weaning does not mean survival, because 20% to 65% of patients weaned from VA ECMO support do not survive to hospital discharge. The high death rate after successful weaning shows that many questions remain unresolved in this field. In this review, we will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature. Based on this information, we will propose a strategy to optimize the weaning process.

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Section: Which Factors Can Help To Predict Successful Weaning From Vamentioning

confidence: 99%

Section: Microcirculation Parametersmentioning

confidence: 99%

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ortuno¹,

Delmas²,

Diehl³

et al. 2019

Ann. Cardiothorac. Surg

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show abstract

“…However, to limit biases due to the absence of randomization, we used a multivariate logistic regression model with a propensity score analysis. Although several definitions of VA-ECMO weaning success have been proposed [11, 29, 30], we adopted the definition used in the recent study by Distelmeier et al [10]. Aortic velocity–time integral and left ventricular ejection fraction were not collected in the control group.…”

Section: Limitationsmentioning

confidence: 99%

Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit

Vally

Ferdynus

Persichini

et al. 2019

Ann. Intensive Care

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BackgroundFew data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU).MethodsThis retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated.ResultsA total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P < 0.0001) and aortic velocity–time integral from 8.9 ± 4 cm to 12.5 ± 3.8 cm (P = 0.002) 24 h after drug infusion. After propensity score matching, levosimendan was the only factor associated with a significant reduction in VA-ECMO weaning failure rates (hazard ratio = 0.16; 95% confidence interval 0.04–0.7; P = 0.01). Kaplan–Meier survival curves showed that survival rates at 30 days were 78.4% for the levosimendan group and 49.5% for the non-levosimendan group (P = 0.02). After propensity score matching analysis, the difference in 30-day mortality between the two groups was not significant (hazard ratio = 0.55; 95% confidence interval 0.27–1.10; P = 0.09).ConclusionsOur results suggest that levosimendan was associated with a beneficial effect on VA-ECMO weaning in ICU patients.

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“…Inhaled nitric oxide improves RV function by reducing pulmonary vascular resistance [ 32 ]. Total vessel density and perfused vessel density monitoring of sublingual microcirculation have been found to have a good association with aortic VTI, LVEF parameters during ECMO wean [ 33 ].…”

Section: Post-cardiotomy Va-ecmomentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation: Special reference for use in ‘post-cardiotomy cardiogenic shock’ — A review with an Indian perspective

Patangi

Shetty

Shanmugasundaram

et al. 2020

Indian J Thorac Cardiovasc Surg

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The ultimate goals of cardiovascular physiology are to ensure adequate end-organ perfusion to satisfy the local metabolic demand, to maintain homeostasis and achieve ‘milieu intérieur’. Cardiogenic shock is a state of pump failure which results in tissue hypoperfusion and its associated complications. There are a wide variety of causes which lead to this deranged physiology, and one such important and common scenario is the post-cardiotomy state which is encountered in cardiac surgical units. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important modality of managing post-cardiotomy cardiogenic shock with variable outcomes which would otherwise be universally fatal. VA-ECMO is considered as a double-edged sword with the advantages of luxurious perfusion while providing an avenue for the failing heart to recover, but with the problems of anticoagulation, inflammatory and adverse systemic effects. Optimal outcomes after VA-ECMO are heavily reliant on a multitude of factors and require a multi-disciplinary team to handle them. This article aims to provide an insight into the pathophysiology of VA-ECMO, cannulation techniques, commonly encountered problems, monitoring, weaning strategies and ethical considerations along with a literature review of current evidence-based practices.

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Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Cited by 62 publications

References 40 publications

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit

Veno-arterial extracorporeal membrane oxygenation: Special reference for use in ‘post-cardiotomy cardiogenic shock’ — A review with an Indian perspective

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