Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No 7, Chung Shang South Road, Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, No 7, Chung Shang South Road, Taipei, Taiwan.
Crit Care. 2018 Aug 19;22(1):200. doi: 10.1186/s13054-018-2081-2.
Microcirculatory dysfunction develops in both septic and cardiogenic shock patients, and it is associated with poor prognosis in patients with septic shock. Information on the association between microcirculatory dysfunction and prognosis in cardiogenic shock patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is limited.
Sublingual microcirculation images were recorded using an incident dark-field video microscope at the following time points: within 12 h (T1), 24 h (T2), 48 h (T3), 72 h (T4), and 96 h (T5) after VA-ECMO placement. If a patient could be weaned off VA-ECMO, sublingual microcirculation images were recorded before and after VA-ECMO removal. Microcirculatory parameters were compared between 28-day nonsurvivors and survivors with VA-ECMO support. In addition, the microcirculation and clinical parameters were assessed as prognostic tests of 28-day mortality, and patients were divided into three subgroups according to microcirculation parameters for survival analysis.
Forty-eight patients were enrolled in this study. At T1, the observed heart rate, mean arterial pressure, inotropic score and lactate level of 28-day nonsurvivors and survivors did not differ significantly, but the perfused small vessel density (PSVD) and proportion of perfused vessels (PPV) were lower in the 28-day nonsurvivors than in the survivors. The PSVD and PPV were slightly superior to lactate levels in predicting 28-day mortality (area under curve of 0.68, 0.70, and 0.62, respectively). The subgroup with the lowest PSVD (< 15 mm/mm) and PPV (< 64%) values exhibited less favorable survival compared with the other two subgroups.
Early microcirculatory parameters could be used to predict the survival of cardiogenic shock patients with VA-ECMO support.
ClinicalTrials.gov, NCT02393274 . Registered on 19 March 2015.
在感染性休克和心源性休克患者中均会出现微循环功能障碍，且其与感染性休克患者的预后不良相关。有关在接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的心源性休克患者中微循环功能障碍与预后之间关系的信息有限。
在 VA-ECMO 放置后 12 小时（T1）、24 小时（T2）、48 小时（T3）、72 小时（T4）和 96 小时（T5），使用暗场视频显微镜记录舌下微循环图像。如果患者可以脱机 VA-ECMO，则在 VA-ECMO 移除前后记录舌下微循环图像。比较 VA-ECMO 支持下 28 天存活者和非存活者的微循环参数。此外，将微循环和临床参数评估为 28 天死亡率的预后测试，并根据微循环参数将患者分为三个亚组进行生存分析。
本研究共纳入 48 例患者。在 T1，28 天非存活者和存活者的观察心率、平均动脉压、正性肌力评分和乳酸水平无显著差异，但 28 天非存活者的灌注小血管密度（PSVD）和灌注血管比例（PPV）较低。PSVD 和 PPV 在预测 28 天死亡率方面略优于乳酸水平（曲线下面积分别为 0.68、0.70 和 0.62）。PSVD（<15mm/mm）和 PPV（<64%）值最低的亚组与其他两个亚组相比，生存情况较差。
早期微循环参数可用于预测接受 VA-ECMO 支持的心源性休克患者的生存情况。
ClinicalTrials.gov，NCT02393274。于 2015 年 3 月 19 日注册。
