Sawada Kenichiro, Kawakami Shoji, Murata Shunsuke, Nishimura Kunihiro, Tahara Yoshio, Hosoda Hayato, Nakashima Takahiro, Kataoka Yu, Asaumi Yasuhide, Noguchi Teruo, Sugimachi Masaru, Fujita Tomoyuki, Kobayashi Junjiro, Yasuda Satoshi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
ESC Heart Fail. 2021 Feb;8(1):471-480. doi: 10.1002/ehf2.13097. Epub 2020 Dec 2.
Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is utilized for patients with cardiogenic shock or cardiac arrest. However, the procedure protocol for weaning from VA-ECMO has not been well established. The present study aimed to determine the usefulness of echocardiographic and pulmonary artery catheter parameters for predicting successful weaning from VA-ECMO in patients with refractory cardiogenic shock.
We retrospectively studied 50 patients who were hospitalized and supported by VA-ECMO for >48 h between January 2013 and March 2017. Patients successfully weaned from VA-ECMO without reintroduction of VA-ECMO or left ventricular assist device implantation were defined as 30 day survivors. Echocardiographic and pulmonary artery catheter parameters were evaluated when ECMO flow was limited to a maximum of 1.5-2.0 L/min. Twenty-four patients were successfully weaned from VA-ECMO, whereas 26 were not. Fractional shortening, corrected left ventricular ejection time (LVETc, defined as LVET divided by the square root of heart rate), left ventricular outflow tract velocity time integral, and LVETc divided by pulmonary artery wedge pressure (PAWP) were significantly larger in the 30 day survivor groups. Multivariable analysis revealed LVETc∕PAWP as a significant independent predictor of successful weaning (LVETc∕PAWP, odds ratio 0.82, 95% confidence interval 0.71-0.94, P = 0.005). Receiver operating characteristic curve analysis revealed 15.9 as the optimal LVETc∕PAWP for predicting successful weaning (area under the curve 0.82).
The present findings indicate that LVETc∕PAWP is a potential predictor of successful weaning from VA-ECMO.
经皮静脉 - 动脉体外膜肺氧合（VA - ECMO）用于心源性休克或心脏骤停患者。然而，VA - ECMO撤机的操作流程尚未完全确立。本研究旨在确定超声心动图和肺动脉导管参数对预测难治性心源性休克患者VA - ECMO成功撤机的有用性。
我们回顾性研究了2013年1月至2017年3月期间住院并接受VA - ECMO支持超过48小时的50例患者。在VA - ECMO支持下未重新启用VA - ECMO或未植入左心室辅助装置且成功撤机的患者被定义为30天存活者。当ECMO流量限制在最大1.5 - 2.0升/分钟时，评估超声心动图和肺动脉导管参数。24例患者成功从VA - ECMO撤机，而26例未成功撤机。30天存活组的缩短分数、校正左心室射血时间（LVETc，定义为LVET除以心率的平方根）、左心室流出道速度时间积分以及LVETc除以肺动脉楔压（PAWP）显著更高。多变量分析显示LVETc∕PAWP是成功撤机的显著独立预测因素（LVETc∕PAWP，比值比0.82，95%置信区间0.71 - 0.94，P = 0.005）。受试者工作特征曲线分析显示，预测成功撤机的最佳LVETc∕PAWP为15.9（曲线下面积0.82）。
本研究结果表明，LVETc∕PAWP是VA - ECMO成功撤机的潜在预测因素。
