Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Microcirculation. 2024 Nov;31(8):e12891. doi: 10.1111/micc.12891. Epub 2024 Oct 10.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used in case of potentially reversible cardiac failure and restores systemic hemodynamics. However, whether this is followed by improvement of microcirculatory perfusion is unknown. Moreover, critically ill patients have possible pre-existing microcirculatory perfusion disturbances. Therefore, this review provides an overview of alterations in sublingual microcirculatory perfusion in critically ill adult patients receiving VA-ECMO support. Pubmed, Embase (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched according to PRISMA guidelines. Studies reporting sublingual microcirculatory perfusion measurements in adult patients supported by VA-ECMO were included. Outcome parameters included small vessel density (SVD), perfused vessel density (PVD), perfused small vessel density (PSVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) and the heterogeneity index (HI). The protocol was registered at PROSPERO (CRD42021243930). The search identified 1215 studies of which 11 were included. Cardiogenic shock was the most common indication for VA-ECMO (n=8). Three studies report increased PSVD, PPV, and MFI 24 hours after initiation of ECMO compared to pre-ECMO. Nonetheless, microcirculatory perfusion stabilized thereafter. Four out of four studies showed higher PSVD and PPV in survivors compared to non-survivors. Over time, survivors showed recovery of microcirculatory perfusion within hours of initiation of ECMO, whereas this was absent in non-survivors. Notwithstanding the limited sample, VA-ECMO seems to improve microcirculatory perfusion shortly after initiation of ECMO, especially in survivors. Further research in larger cohorts is needed to clarify the longitudinal effects of ECMO on microcirculatory perfusion.
静脉-动脉体外膜肺氧合（VA-ECMO）用于潜在可逆转的心力衰竭，并恢复全身血液动力学。然而，是否随后改善了微循环灌注尚不清楚。此外，危重症患者可能存在预先存在的微循环灌注障碍。因此，本综述提供了关于接受 VA-ECMO 支持的成年危重症患者舌下微循环灌注改变的概述。根据 PRISMA 指南，系统地检索了 PubMed、Embase（Ovid）、Cochrane 对照试验中心注册库和 Web of Science。纳入了报告 VA-ECMO 支持的成年患者舌下微循环灌注测量的研究。观察指标包括小血管密度（SVD）、灌注血管密度（PVD）、灌注小血管密度（PSVD）、灌注血管比例（PPV）、微血管血流指数（MFI）和异质性指数（HI）。该方案在 PROSPERO（CRD42021243930）上进行了注册。检索到 1215 项研究，其中 11 项被纳入。心源性休克是 VA-ECMO 最常见的适应证（n=8）。3 项研究报告 ECMO 启动后 24 小时 PSVD、PPV 和 MFI 增加，与 ECMO 前相比。尽管如此，此后微循环灌注稳定下来。4 项研究中的 4 项显示存活者的 PSVD 和 PPV 高于非存活者。随着时间的推移，存活者在 ECMO 启动后数小时内显示出微循环灌注的恢复，而非存活者则没有。尽管样本有限，VA-ECMO 似乎在 ECMO 启动后不久就改善了微循环灌注，尤其是在存活者中。需要进一步在更大的队列中进行研究，以阐明 ECMO 对微循环灌注的纵向影响。
