Lashin Hazem, Olusanya Olusegun, Smith Andrew, Bhattacharyya Sanjeev
Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom.
J Cardiothorac Vasc Anesth. 2024 Jan;38(1):133-140. doi: 10.1053/j.jvca.2023.10.014. Epub 2023 Oct 13.
The authors investigated if the use of ultrasound-enhancing agents (UEA) can safely improve left ventricular (LV) image quality by transthoracic echocardiography (TTE) in patients on extracorporeal membrane oxygenation (ECMO).
This study was performed in a tertiary cardiothoracic and ECMO center in London, United Kingdom.
The authors included 18 prospectively identified consecutive patients requiring TEE supported on peripherally implanted ECMO.
TTE was performed before and after the UEA administration. The authors assessed the LV image quality using the biplane (apical-4-chamber and apical-2-chamber views) endocardial border definition index (1 = good, 2 = suboptimal, 3 = poor, and 4 = unavailable), as well as the feasibility of LV ejection fraction (LVEF) measurement. The authors also gathered sequential clinical information for the next 24 hours.
The patients' median age was 47 years (35, 65), and 5 (28%) were women. The biplane endocardial border definition index improved from the suboptimal to the good range (2.167 [1.812, 3.042] v 1.500 [1.417, 1.792], p = 0.0004) after the use of UEA. The feasibility of LVEF tripled from 25% (n = 5) to 83% (n = 15) (p = 0.0008) with UEA use. The UEA did not set off the bubble alarm and did not impact clinical or ECMO parameters.
The use of UEA significantly improved the quality of LV biplane images by transthoracic echocardiography, transforming them from suboptimal to good in patients supported with peripherally implanted ECMO. UEA use tripled the feasibility of measuring LVEF by TTE without affecting clinical and ECMO parameters.
作者研究了在体外膜肺氧合（ECMO）支持下的患者中，使用超声增强剂（UEA）能否通过经胸超声心动图（TTE）安全地改善左心室（LV）图像质量。
本研究在英国伦敦的一家三级心胸外科和ECMO中心进行。
作者纳入了18例经前瞻性确定的连续患者，这些患者需要在外周植入ECMO支持下进行经食管超声心动图（TEE）检查。
在给予UEA前后进行TTE检查。作者使用双平面（心尖四腔心和心尖两腔心视图）的心内膜边界定义指数（1 = 良好，2 = 次优，3 = 差，4 = 不可用）评估LV图像质量，以及测量左心室射血分数（LVEF）的可行性。作者还收集了接下来24小时的连续临床信息。
患者的中位年龄为47岁（35, 65），5例（28%）为女性。使用UEA后，双平面心内膜边界定义指数从次优范围改善到良好范围（2.167 [1.812, 3.042] 对 1.500 [1.417, 1.792]，p = 0.0004）。使用UEA后，LVEF测量的可行性从25%（n = 5）增加到83%（n = 15）（p = 0.0008）。UEA未触发气泡警报，也未影响临床或ECMO参数。
在接受外周植入ECMO支持的患者中，使用UEA通过经胸超声心动图显著改善了LV双平面图像的质量，使其从次优变为良好。使用UEA使通过TTE测量LVEF的可行性增加了两倍，且不影响临床和ECMO参数。
