Noninvasive assessment of hemodynamic variables using near-infrared spectroscopy in patients experiencing cardiogenic shock and individuals undergoing venoarterial extracorporeal membrane oxygenation

Ošťádal, Petr; Krüger, Andreas; Vondráková, Dagmar; Janotka, Marek; Psotova, Hana; Neužil, Petr

doi:10.1016/j.jcrc.2014.02.003

Cited by 18 publications

(13 citation statements)

References 15 publications

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“…This is a highly clinically relevant issue, with risk for not only myocardial but also brain hypoxia. Monitoring coronary blood oxygen saturation is technically difficult in clinical settings; however, near-infrared spectroscopy oximetry offers continuous noninvasive measurement of brain oxygen saturation [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock

et al. 2015

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BackgroundThe aim of this study was to assess the relationship between extracorporeal blood flow (EBF) and left ventricular (LV) performance during venoarterial extracorporeal membrane oxygenation (VA ECMO) therapy.MethodsFive swine (body weight 45 kg) underwent VA ECMO implantation under general anesthesia and artificial ventilation. Subsequently, acute cardiogenic shock with signs of tissue hypoxia was induced. Hemodynamic and cardiac performance parameters were then measured at different levels of EBF (ranging from 1 to 5 L/min) using arterial and venous catheters, a pulmonary artery catheter and a pressure–volume loop catheter introduced into the left ventricle.ResultsMyocardial hypoxia resulted in a decline in mean (±SEM) cardiac output to 2.8 ± 0.3 L/min and systolic blood pressure (SBP) to 60 ± 7 mmHg. With an increase in EBF from 1 to 5 L/min, SBP increased to 97 ± 8 mmHg (P < 0.001); however, increasing EBF from 1 to 5 L/min significantly negatively influences several cardiac performance parameters: cardiac output decreased form 2.8 ± 0.3 L/min to 1.86 ± 0.53 L/min (P < 0.001), LV end-systolic volume increased from 64 ± 11 mL to 83 ± 14 mL (P < 0.001), LV stroke volume decreased from 48 ± 9 mL to 40 ± 8 mL (P = 0.045), LV ejection fraction decreased from 43 ± 3 % to 32 ± 3 % (P < 0.001) and stroke work increased from 2096 ± 342 mmHg mL to 3031 ± 404 mmHg mL (P < 0.001). LV end-diastolic pressure and volume were not significantly affected.ConclusionsThe results of the present study indicate that higher levels of VA ECMO blood flow in cardiogenic shock may negatively affect LV function. Therefore, it appears that to mitigate negative effects on LV function, optimal VA ECMO blood flow should be set as low as possible to allow adequate tissue perfusion.

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Section: Discussionmentioning

confidence: 99%

Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock

et al. 2015

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“…29,30 Noninvasive monitoring of cerebral and splanchnic oxygen saturation is being increasingly advocated as a reliable assessment of oxygen delivery to the vital organs of the body. 31,32 However, it must be noted that the clinical reliability of the use of near-infrared spectroscopy to monitor oxygen delivery remains controversial. 33 Tissue oxygen delivery is determined not only by S aO 2 but also by the patient's hemoglobin content, cardiac output, oxygen affinity of hemoglobin, oxygen extraction ratio, and metabolic demands.…”

Section: Oxygen Deliverymentioning

confidence: 99%

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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The overall goal of the cardiorespiratory system is to provide the organs and tissues of the body with an adequate supply of oxygen in relation to oxygen consumption. An understanding of the complex physiologic interactions between the respiratory and cardiac systems is essential to optimal patient management. Alterations in intrathoracic pressure are transmitted to the heart and lungs and can dramatically alter cardiovascular performance, with significant differences existing between the physiologic response of the right and left ventricles to changes in intrathoracic pressure. In terms of cardiorespiratory interactions, the clinician should titrate the mean airway pressure to optimize the balance between mean lung volume (ie, arterial oxygenation) and ventricular function (ie, global cardiac output), minimize pulmonary vascular resistance, and routinely monitor cardiorespiratory parameters closely. Oxygen delivery to all organs and tissues of the body should be optimized, but not necessarily maximized. The heart and lungs are, obviously, connected anatomically but also physiologically in a complex relationship.

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“…Especially in this context of LV overload, evaluation of VA ECMO in experiments with heart failure (HF) models have become important before translations to clinical practice. LV performance has been studied on models with intact or acutely decompensated hearts [6,8,[19][20][21][22], but to our knowledge, there have been no experimental studies on hemodynamic effects of VA ECMO in conditions of chronic HF and its decompensation. Even though a significant part of VA ECMO clinical applications is for circulatory decompensation developed on grounds of previously present chronic heart disease, we still lack evidence from corresponding experiments.…”

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confidence: 99%

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

et al. 2020

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Background: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in the treatment of circulatory failure, but repeatedly, its negative effects on the left ventricle (LV) have been observed. The purpose of this study is to assess the influence of increasing extracorporeal blood flow (EBF) on LV performance during VA ECMO therapy of decompensated chronic heart failure. Methods: A porcine model of low-output chronic heart failure was developed by long-term fast cardiac pacing. Subsequently, under total anesthesia and artificial ventilation, VA ECMO was introduced to a total of five swine with profound signs of chronic cardiac decompensation. LV performance and organ specific parameters were recorded at different levels of EBF using a pulmonary artery catheter, a pressure-volume loop catheter positioned in the LV, and arterial flow probes on systemic arteries. Results: Tachycardia-induced cardiomyopathy led to decompensated chronic heart failure with mean cardiac output of 2.9 ± 0.4 L/min, severe LV dilation, and systemic hypoperfusion. By increasing the EBF from minimal flow to 5 L/min, we observed a gradual increase of LV peak pressure from 49 ± 15 to 73 ± 11 mmHg (P = 0.001) and an improvement in organ perfusion. On the other hand, cardiac performance parameters revealed higher demands put on LV function: LV end-diastolic pressure increased from 7 ± 2 to 15 ± 3 mmHg, end-diastolic volume increased from 189 ± 26 to 218 ± 30 mL, end-systolic volume increased from 139 ± 17 to 167 ± 15 mL (all P < 0.001), and stroke work increased from 1434 ± 941 to 1892 ± 1036 mmHg*mL (P < 0.05). LV ejection fraction and isovolumetric contractility index did not change significantly. Conclusions: In decompensated chronic heart failure, excessive VA ECMO flow increases demands and has negative effects on the workload of LV. To protect the myocardium from harm, VA ECMO flow should be adjusted with respect to not only systemic perfusion, but also to LV parameters.

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Noninvasive assessment of hemodynamic variables using near-infrared spectroscopy in patients experiencing cardiogenic shock and individuals undergoing venoarterial extracorporeal membrane oxygenation

Cited by 18 publications

References 15 publications

Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock

Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

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