The Sublingual Microcirculation Throughout Neonatal and Pediatric Extracorporeal Membrane Oxygenation Treatment: Is It Altered by Systemic Extracorporeal Support?

Frontiers in Pediatrics

article

Özge Erdem¹  Jan Willem Kuiper¹  Joost van Rosmalen²  Robert Jan Houmes¹  Enno D. Wildschut¹  Can Ince³  Dick Tibboel¹ 

[1] Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center—Sophia Children's Hospital;Department of Biostatistics, Erasmus University Medical Center;Department of Intensive Care, Erasmus University Medical Center;Department of Translational Physiology, Amsterdam University Medical Center

关键词: microcirculation;    hemodynamic monitoring;    extracorporeal membrane oxygenation;    critical care;    pediatrics;    neonates;   

DOI  :  10.3389/fped.2019.00272

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Extracorporeal membrane oxygenation (ECMO) treatment alleviates systemic cardiorespiratory failure. However, it is unclear whether ECMO also improves microcirculatory function, as the microcirculation can be disturbed despite normal systemic hemodynamics. We therefore aimed to study the sublingual microcirculation (SMC) throughout neonatal and pediatric ECMO treatment. We hypothesized that the SMC improves after starting ECMO, that the SMC differs between venovenous (VV) and venoarterial (VA) ECMO, and that insufficient recovery of microcirculatory disturbances during ECMO predicts mortality. Methods: This single-center prospective longitudinal observational study included 34 consecutive children (April 2016—September 2018). The SMC was assessed daily with a handheld vital microscope (integrated with incident dark field illumination) before, during, and after ECMO. Validated parameters of vessel density, perfusion, and flow quality were assessed for all vessels (diameter 2.6) increased with higher MAP (OR: 1.050, 95%CI: 1.008–1.094). Microcirculatory parameters did not significantly differ between VV and VA ECMO or between survivors and non-survivors. None of the microcirculatory parameters could predict mortality on ECMO or overall mortality. Conclusion: In this heterogeneous study population, we were not able to demonstrate an effect of ECMO on the sublingual microcirculation. Microcirculatory parameters did not change throughout ECMO treatment and did not differ between VV and VA ECMO or between survivors and non-survivors. Future research should focus on determining which neonatal and pediatric ECMO patients would benefit from microcirculatory monitoring and how.

【 授权许可】

CC BY