Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

Lundemoen, Steinar; Kvalheim, Venny Lise; Mongstad, Arve; Andersen, Knut-Jan; Grong, Ketil; Husby, Paul

doi:10.1016/j.jtcvs.2013.06.002

Cited by 10 publications

(11 citation statements)

References 24 publications

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“…While IABP may provide a pulsatile flow, many studies have shown that this was of no benefit to the microcirculation [20, 35, 36]. All of these factors might have detrimental effects on the microcirculation and may explain why the microcirculatory parameters decreased from T1 to T2 in both groups.…”

Section: Discussionmentioning

confidence: 99%

Microcirculatory assessment of patients under VA-ECMO

et al. 2016

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BackgroundVeno-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.MethodsTwenty-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.ResultsOf 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/mm2, 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).ConclusionPVD of the sublingual microcirculation at initiation of VA-ECMO can be used to predict ICU mortality in patients with cardiogenic shock.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1519-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Microcirculatory assessment of patients under VA-ECMO

et al. 2016

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“…Standard equipment for an open heart operation was used, including a Quadrox-I Adult microporous membrane oxygenator, VHK 2000, venous hard-shell reservoir, and standard heart-lung machine tubings equipped with a Maquet Rotaflow Centrifugal Pump RF-32 (Maquet Cardiopulmonary AG, Hirrlingen, Germany), as recently described [19].…”

Section: Instrumentation and Cpbmentioning

confidence: 99%

Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion

Lundemoen

Kvalheim

Svendsen

et al. 2015

The Annals of Thoracic Surgery

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confidence: 99%

“…Recently, we evaluated microvascular fluid exchange [11] and tissue perfusion [12] when "real" pulsatility was achieved by combining a centrifugal pump and intraaortic counterpulsation (IABP) during bypass. Under these conditions benefits of pulsatility on microvascular fluid exchange were absent [11]. Note that pulsatility achieved with the use of IABP may interfere with microvascular fluid balance through IABP-induced intraaortic obstruction [12] that affects the central venous pressure and the capillary hydrostatic pressure that partly controls fluid exchange at the microvascular level.…”

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confidence: 99%

Does Roller Pump–Induced Pulsatile CPB Perfusion Affect Microvascular Fluid Shifts and Tissue Perfusion?

Elvevoll

Lundemoen

Svendsen

et al. 2016

The Annals of Thoracic Surgery

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Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

Abstract: No significant differences in the fluid extravasation rates were present between pulsed and nonpulsed cardiopulmonary bypass perfusion in the present experimental setup.

Cited by 10 publications

References 24 publications

Microcirculatory assessment of patients under VA-ECMO

Microcirculatory assessment of patients under VA-ECMO

Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion

Does Roller Pump–Induced Pulsatile CPB Perfusion Affect Microvascular Fluid Shifts and Tissue Perfusion?

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