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

Ostadal P, Mlcek M, Kruger A, Hala P, Lacko S, Mates M, Vondrakova D, Svoboda T, Hrachovina M, Janotka M, Psotova H, Strunina S, Kittnar O, Neuzil P - J Transl Med (2015)

Bottom Line: 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.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.LV end-diastolic pressure and volume were not significantly affected.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Center, Na Homolce Hospital, 15030, Prague, Czech Republic. ostadal.petr@gmail.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Parameters measured from pressure–volume loop. EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, SBP systolic blood pressure, SW stroke work
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Fig1: Parameters measured from pressure–volume loop. EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, SBP systolic blood pressure, SW stroke work

Mentions: A pressure–volume (PV) conductance catheter (Scisense 7F VSL Pigtail, Transonic, USA) was introduced into the left ventricle from the left carotid artery through the aortic valve. The catheter was connected to the PV unit (Sciense ADV 500, Transonic, USA) and operated in admittance mode. Correct positioning was assessed radiographically by confirming optimal PV loop morphology. The volume was calibrated against pulmonary thermodilution (Combo CCO catheter, Edwards Lifesciences, USA) at baseline. The PV values were recorded continually during the experiment, and data from five end-expiration loops at the end of each level of EBF were averaged and used for the analysis. Collected data included end-diastolic pressure (EDP), end-diastolic volume (EDV), systolic blood pressure (SBP), end-systolic volume (ESV) and stroke work (SW) (Fig. 1).Fig. 1


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

Ostadal P, Mlcek M, Kruger A, Hala P, Lacko S, Mates M, Vondrakova D, Svoboda T, Hrachovina M, Janotka M, Psotova H, Strunina S, Kittnar O, Neuzil P - J Transl Med (2015)

Parameters measured from pressure–volume loop. EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, SBP systolic blood pressure, SW stroke work
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537539&req=5

Fig1: Parameters measured from pressure–volume loop. EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, SBP systolic blood pressure, SW stroke work
Mentions: A pressure–volume (PV) conductance catheter (Scisense 7F VSL Pigtail, Transonic, USA) was introduced into the left ventricle from the left carotid artery through the aortic valve. The catheter was connected to the PV unit (Sciense ADV 500, Transonic, USA) and operated in admittance mode. Correct positioning was assessed radiographically by confirming optimal PV loop morphology. The volume was calibrated against pulmonary thermodilution (Combo CCO catheter, Edwards Lifesciences, USA) at baseline. The PV values were recorded continually during the experiment, and data from five end-expiration loops at the end of each level of EBF were averaged and used for the analysis. Collected data included end-diastolic pressure (EDP), end-diastolic volume (EDV), systolic blood pressure (SBP), end-systolic volume (ESV) and stroke work (SW) (Fig. 1).Fig. 1

Bottom Line: 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.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.LV end-diastolic pressure and volume were not significantly affected.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Center, Na Homolce Hospital, 15030, Prague, Czech Republic. ostadal.petr@gmail.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus