Author + information
- Sakir Akin,
- Dinis dos Reis Miranda,
- Kadir Caliskan,
- Osama Soliman,
- Atila Kara,
- Ard Struijs,
- Robert J. van Thiel,
- L.S.D. Jewbali,
- Alex Lima,
- Diederik Gommers,
- Felix Zijlstra and
- Can Ince
Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of cardiogenic shock. However, marker of successful weaning remains largely unknown. We sought to examine microcirculation as a new method for weaning.
Methods: Weaning was performed by decreasing the VA-ECMO flow to 50% from the baseline with minimal inotropic support. The endpoint of the study was successful VA-ECMO explantation within 48 hours after weaning. Microcirculation was measured in the same sublingual area using Cytocam Incident dark field (IDF) imaging at baseline and during weaning attempts. We quantified total-vessel-density(TVD) as a potential marker for weaning.
Results: The study population consisted 13 patients in cardiogenic shock due to pulmonary embolism (n=4; 31%) and postcardiac surgery patients (n=3; 23%) and various etiologies in the rest of the patients, 11 (85%) male and median age 55 [23-80]. TVD > 12.2 mm/mm2 showed higher sensitivity and specificity for prediction of successful weaning (n=9), compared with deterioration in all non-successful (n=10) weaning attempts (Figure). TVD > 12.2 mm/mm2 has better sensitivity, specificity and AUC (0,989 vs 0,878) compared with aortic velocity-time integral (VTI) > 11 cm on ROC analysis (Figure).
Conclusions: Microcirculatory imaging is a simple, fast and highly specific bedside technique that could be used to identify recovery from cardiogenic shock, and subsequently successful weaning from VA-ECMO.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure and Cardiomyopathies: What Next When All Else Is Failing?
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1248-247
- 2017 American College of Cardiology Foundation