Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study

Tzu Jung Wei; Chih Hsien Wang; Wing Sum Chan; Chi Hsiang Huang; Chien Heng Lai; Ming Jiuh Wang; Yih Sharng Chen; Can Ince; Tzu Yu Lin; Yu Chang Yeh

doi:10.3389/fmed.2021.649263

Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study

Tzu Jung Wei, Chih Hsien Wang, Wing Sum Chan, Chi Hsiang Huang, Chien Heng Lai, Ming Jiuh Wang, Yih Sharng Chen, Can Ince, Tzu Yu Lin, Yu Chang Yeh^*

^*Corresponding author for this work

Intensive Care

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining organ perfusion in patients with cardiogenic shock, but VA-ECMO pump flow optimization remains as a clinical challenge. This study aimed to investigate the response of sublingual microcirculation to changes in VA-ECMO pump flow. Methods: Sublingual microcirculation was measured before and after changing VA-ECMO pump flow according to the treatment plan of ECMO team within 24 h and at 24-48 h after VA-ECMO placement. In clinical events of increasing VA-ECMO pump flow, those events with increased perfused vessel density (PVD) were grouped into group A, and the others were grouped into group B. In clinical events of decreasing VA-ECMO pump flow, those events with increased PVD were grouped into group C, and the others were grouped into group D. Results: Increased PVD was observed in 60% (95% CI, 38.5–81.5%) of the events with increasing VA-ECMO pump flow. The probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm² at baseline than those with a PVD ≥ 15 mm/mm² [100% (95% CI, 54.1–100%) vs. 42.9% (95% CI, 17.7–71.1%), P = 0.042]. Other microcirculatory and hemodynamic parameters at baseline did not differ significantly between group A and B or between group C and D. Conclusion: This study revealed contradictory and non-contradictory responses of sublingual microcirculation to changes in VA-ECMO pump flow. Tandem measurements of microcirculation before and after changing VA-ECMO pump flow may help to ensure a good microcirculation.

Original language	English
Article number	649263
Journal	Frontiers in Medicine
Volume	8
DOIs	https://doi.org/10.3389/fmed.2021.649263
Publication status	Published - 7 Apr 2021

Bibliographical note

FUNDING:
This work was supported, in part, by a grant from the Far Eastern Memorial Hospital and National Taiwan University Hospital
Joint Research Program (106-FTN13), a grant from the Ministry of Science and Technology, Taiwan (MOST 107-2314-B-002- 067-MY2),
and a fund from the National Taiwan University Hospital (MS456).

Publisher Copyright: © Copyright © 2021 Wei, Wang, Chan, Huang, Lai, Wang, Chen, Ince, Lin and Yeh.

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10.3389/fmed.2021.649263

fmed-08-649263Licence: CC BY

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@article{11720f735efb4d2198525d7162ff3e56,

title = "Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study",

abstract = "Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining organ perfusion in patients with cardiogenic shock, but VA-ECMO pump flow optimization remains as a clinical challenge. This study aimed to investigate the response of sublingual microcirculation to changes in VA-ECMO pump flow. Methods: Sublingual microcirculation was measured before and after changing VA-ECMO pump flow according to the treatment plan of ECMO team within 24 h and at 24-48 h after VA-ECMO placement. In clinical events of increasing VA-ECMO pump flow, those events with increased perfused vessel density (PVD) were grouped into group A, and the others were grouped into group B. In clinical events of decreasing VA-ECMO pump flow, those events with increased PVD were grouped into group C, and the others were grouped into group D. Results: Increased PVD was observed in 60% (95% CI, 38.5–81.5%) of the events with increasing VA-ECMO pump flow. The probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm2 at baseline than those with a PVD ≥ 15 mm/mm2 [100% (95% CI, 54.1–100%) vs. 42.9% (95% CI, 17.7–71.1%), P = 0.042]. Other microcirculatory and hemodynamic parameters at baseline did not differ significantly between group A and B or between group C and D. Conclusion: This study revealed contradictory and non-contradictory responses of sublingual microcirculation to changes in VA-ECMO pump flow. Tandem measurements of microcirculation before and after changing VA-ECMO pump flow may help to ensure a good microcirculation.",

author = "Wei, {Tzu Jung} and Wang, {Chih Hsien} and Chan, {Wing Sum} and Huang, {Chi Hsiang} and Lai, {Chien Heng} and Wang, {Ming Jiuh} and Chen, {Yih Sharng} and Can Ince and Lin, {Tzu Yu} and Yeh, {Yu Chang}",

note = "FUNDING: This work was supported, in part, by a grant from the Far Eastern Memorial Hospital and National Taiwan University Hospital Joint Research Program (106-FTN13), a grant from the Ministry of Science and Technology, Taiwan (MOST 107-2314-B-002- 067-MY2), and a fund from the National Taiwan University Hospital (MS456). Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Wei, Wang, Chan, Huang, Lai, Wang, Chen, Ince, Lin and Yeh.",

year = "2021",

month = apr,

day = "7",

doi = "10.3389/fmed.2021.649263",

language = "English",

volume = "8",

}

TY - JOUR

T1 - Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow

T2 - A Prospective Observational Study

AU - Wei, Tzu Jung

AU - Wang, Chih Hsien

AU - Chan, Wing Sum

AU - Huang, Chi Hsiang

AU - Lai, Chien Heng

AU - Wang, Ming Jiuh

AU - Chen, Yih Sharng

AU - Ince, Can

AU - Lin, Tzu Yu

AU - Yeh, Yu Chang

N1 - FUNDING: This work was supported, in part, by a grant from the Far Eastern Memorial Hospital and National Taiwan University Hospital Joint Research Program (106-FTN13), a grant from the Ministry of Science and Technology, Taiwan (MOST 107-2314-B-002- 067-MY2), and a fund from the National Taiwan University Hospital (MS456). Publisher Copyright: © Copyright © 2021 Wei, Wang, Chan, Huang, Lai, Wang, Chen, Ince, Lin and Yeh.

PY - 2021/4/7

Y1 - 2021/4/7

N2 - Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining organ perfusion in patients with cardiogenic shock, but VA-ECMO pump flow optimization remains as a clinical challenge. This study aimed to investigate the response of sublingual microcirculation to changes in VA-ECMO pump flow. Methods: Sublingual microcirculation was measured before and after changing VA-ECMO pump flow according to the treatment plan of ECMO team within 24 h and at 24-48 h after VA-ECMO placement. In clinical events of increasing VA-ECMO pump flow, those events with increased perfused vessel density (PVD) were grouped into group A, and the others were grouped into group B. In clinical events of decreasing VA-ECMO pump flow, those events with increased PVD were grouped into group C, and the others were grouped into group D. Results: Increased PVD was observed in 60% (95% CI, 38.5–81.5%) of the events with increasing VA-ECMO pump flow. The probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm2 at baseline than those with a PVD ≥ 15 mm/mm2 [100% (95% CI, 54.1–100%) vs. 42.9% (95% CI, 17.7–71.1%), P = 0.042]. Other microcirculatory and hemodynamic parameters at baseline did not differ significantly between group A and B or between group C and D. Conclusion: This study revealed contradictory and non-contradictory responses of sublingual microcirculation to changes in VA-ECMO pump flow. Tandem measurements of microcirculation before and after changing VA-ECMO pump flow may help to ensure a good microcirculation.

AB - Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining organ perfusion in patients with cardiogenic shock, but VA-ECMO pump flow optimization remains as a clinical challenge. This study aimed to investigate the response of sublingual microcirculation to changes in VA-ECMO pump flow. Methods: Sublingual microcirculation was measured before and after changing VA-ECMO pump flow according to the treatment plan of ECMO team within 24 h and at 24-48 h after VA-ECMO placement. In clinical events of increasing VA-ECMO pump flow, those events with increased perfused vessel density (PVD) were grouped into group A, and the others were grouped into group B. In clinical events of decreasing VA-ECMO pump flow, those events with increased PVD were grouped into group C, and the others were grouped into group D. Results: Increased PVD was observed in 60% (95% CI, 38.5–81.5%) of the events with increasing VA-ECMO pump flow. The probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm2 at baseline than those with a PVD ≥ 15 mm/mm2 [100% (95% CI, 54.1–100%) vs. 42.9% (95% CI, 17.7–71.1%), P = 0.042]. Other microcirculatory and hemodynamic parameters at baseline did not differ significantly between group A and B or between group C and D. Conclusion: This study revealed contradictory and non-contradictory responses of sublingual microcirculation to changes in VA-ECMO pump flow. Tandem measurements of microcirculation before and after changing VA-ECMO pump flow may help to ensure a good microcirculation.

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U2 - 10.3389/fmed.2021.649263

DO - 10.3389/fmed.2021.649263

M3 - Article

AN - SCOPUS:85104630747

VL - 8

M1 - 649263

ER -

Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study

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