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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

The effect of venoarterial extracorporeal membrane oxygenation blood flow on selected hemodynamic and left ventricular performance parameters in a porcine model of cardiogenic shock. EBF extracorporeal blood flow, EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, HR heart rate, LVEF left ventricular ejection fraction, SBP systolic blood pressure, SV stroke volume, SW stroke work. *P < 0.05 compared with value at EBF 1 L/min
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Fig3: The effect of venoarterial extracorporeal membrane oxygenation blood flow on selected hemodynamic and left ventricular performance parameters in a porcine model of cardiogenic shock. EBF extracorporeal blood flow, EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, HR heart rate, LVEF left ventricular ejection fraction, SBP systolic blood pressure, SV stroke volume, SW stroke work. *P < 0.05 compared with value at EBF 1 L/min

Mentions: With increasing EBF, an increase in SBP was observed, from 60 ± 7 mmHg to 72 ± 7, 81 ± 6, 89 ± 7 and 97 ± 8 mmHg, respectively (EBF 1, 2, 3, 4 and 5 L/min; P < 0.001) (Fig. 3a); HR decreased from 94 ± 4 beats/min to 89 ± 3, 84 ± 3, 80 ± 2 and 77 ± 2 beats/min, respectively (EBF 1–5 L/min; P < 0.001) (Fig. 3b); PCO decreased from 2.81 ± 0.34 L/min to 2.49 ± 0.25, 2.21 ± 0.21, 1.84 ± 0.31 and 1.86 ± 0.53 L/min, respectively (EBF 1–5 L/min; P = 0.005) (Table 1); ESV increased from 64 ± 11 mL to 70 ± 11, 74 ± 11, 78 ± 12 and 83 ± 14 mL, respectively (EBF 1–5 L/min; P < 0.001) (Fig. 3c); EDV did not change significantly (112 ± 19, 115 ± 19, 116 ± 19, 119 ± 19 and 123 ± 20 mL, respectively; EBF 1–5 L/min, P = 0.43) (Fig. 3d); and although there was only a numerical increase in EDP from 17.2 ± 1.4 mmHg to 18.2 ± 0.7, 18.6 ± 1.5, 18.9 ± 2.4 and 19.0 ± 2.9 mmHg, respectively, these differences were not statistically significant (EBF 1–5 L/min; P = 0.87) (Fig. 3e). Finally, SW increased from 2096 ± 342 mmHg mL to 2510 ± 335, 2752 ± 346, 3031 ± 404 and 2884 ± 412 mmHg mL, respectively (EBF 1–5 L/min; P < 0.001) (Fig. 3f).Fig. 3


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)

The effect of venoarterial extracorporeal membrane oxygenation blood flow on selected hemodynamic and left ventricular performance parameters in a porcine model of cardiogenic shock. EBF extracorporeal blood flow, EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, HR heart rate, LVEF left ventricular ejection fraction, SBP systolic blood pressure, SV stroke volume, SW stroke work. *P < 0.05 compared with value at EBF 1 L/min
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: The effect of venoarterial extracorporeal membrane oxygenation blood flow on selected hemodynamic and left ventricular performance parameters in a porcine model of cardiogenic shock. EBF extracorporeal blood flow, EDP end-diastolic pressure, EDV end-diastolic volume, ESV end-systolic volume, HR heart rate, LVEF left ventricular ejection fraction, SBP systolic blood pressure, SV stroke volume, SW stroke work. *P < 0.05 compared with value at EBF 1 L/min
Mentions: With increasing EBF, an increase in SBP was observed, from 60 ± 7 mmHg to 72 ± 7, 81 ± 6, 89 ± 7 and 97 ± 8 mmHg, respectively (EBF 1, 2, 3, 4 and 5 L/min; P < 0.001) (Fig. 3a); HR decreased from 94 ± 4 beats/min to 89 ± 3, 84 ± 3, 80 ± 2 and 77 ± 2 beats/min, respectively (EBF 1–5 L/min; P < 0.001) (Fig. 3b); PCO decreased from 2.81 ± 0.34 L/min to 2.49 ± 0.25, 2.21 ± 0.21, 1.84 ± 0.31 and 1.86 ± 0.53 L/min, respectively (EBF 1–5 L/min; P = 0.005) (Table 1); ESV increased from 64 ± 11 mL to 70 ± 11, 74 ± 11, 78 ± 12 and 83 ± 14 mL, respectively (EBF 1–5 L/min; P < 0.001) (Fig. 3c); EDV did not change significantly (112 ± 19, 115 ± 19, 116 ± 19, 119 ± 19 and 123 ± 20 mL, respectively; EBF 1–5 L/min, P = 0.43) (Fig. 3d); and although there was only a numerical increase in EDP from 17.2 ± 1.4 mmHg to 18.2 ± 0.7, 18.6 ± 1.5, 18.9 ± 2.4 and 19.0 ± 2.9 mmHg, respectively, these differences were not statistically significant (EBF 1–5 L/min; P = 0.87) (Fig. 3e). Finally, SW increased from 2096 ± 342 mmHg mL to 2510 ± 335, 2752 ± 346, 3031 ± 404 and 2884 ± 412 mmHg mL, respectively (EBF 1–5 L/min; P < 0.001) (Fig. 3f).Fig. 3

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