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

Journal of Translational Medicine

Petr Neuzil³  Otomar Kittnar¹  Svitlana Strunina²  Hana Psotova³  Marek Janotka³  Matej Hrachovina¹  Tomas Svoboda¹  Dagmar Vondrakova³  Martin Mates³  Stanislav Lacko¹  Pavel Hala³  Andreas Kruger³  Mikulas Mlcek¹  Petr Ostadal³ 

[1] Department of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic;Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic;Cardiovascular Center, Na Homolce Hospital, Prague, 15030, Czech Republic

关键词: Cardiogenic shock;    Left ventricle;    Cardiac performance;    Extracorporeal life support;    Extracorporeal membrane oxygenation;   

Others  :  1235221
DOI  :  10.1186/s12967-015-0634-6

 received in 2015-02-01, accepted in 2015-08-11,  发布年份 2015

【 摘 要 】

Background

The 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.

Methods

Five 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.

Results

Myocardial 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.

Conclusions

The 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.

【 授权许可】

   
2015 Ostadal et al.

【 图 表 】

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