Echocardiographic Predictors of Successful Extracorporeal Membrane Oxygenation Weaning After Refractory Cardiogenic Shock
Echocardiographic Predictors of Successful Extracorporeal Membrane Oxygenation Weaning After Refractory Cardiogenic Shock
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DOI：
10.1016/j.echo.2020.12.002
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发表时间：
2021-03-31
影响因子：
6.5
通讯作者：
Yang, Jeong Hoon
中科院分区：
文献类型：
--
作者：
Kim, Darae;Jang, Woo Jin;Yang, Jeong Hoon
背景资料：关于成功脱离静脉动脉（VA）体外膜肺氧合（ECMO）的超声心动图预测因素的可用数据有限。我们试图确定ECMO血流研究期间的超声心动图参数是否可以预测成功脱离ECMO.Methods：共有92例ECMO患者从一个多中心ECMO注册表进行VA-ECMO血流研究，经胸超声心动图脱机试验前。在VA-ECMO血流研究期间，将流量降低至初始流量的30%-50%，持续15分钟，并在基线和流量降低后进行超声心动图检查。结果：92例患者中64例成功脱离VA-ECMO。在VA-ECMO血流研究中，成功脱机组的侧向e'和三尖瓣环S'速度均显著改善，而脱机失败组未观察到这些结果。单因素分析显示，左心减压、外侧e'速度改善和三尖瓣环S'速度改善与成功的VA-ECMO撤机显著相关。根据ECMO流量的减少，外侧e'和三尖瓣环S'的变化对成功脱离VA-ECMO的模型的预测性远高于先前研究中传统超声心动图预测因子的模型（左心室射血分数> 20%-25%，左心室时间-速度积分>= 10 cm，二尖瓣环S' >= 6 cm/sec）。在VA-ECMO血流研究中，与最小血流时的常规超声心动图参数相比，侧向e'速度和三尖瓣环S'速度的改善可能更好地代表恢复心脏的心脏储备。在ECMO血流研究期间评估组织多普勒参数是一种简单可行的方法，可指导医生确定ECMO脱机的最佳时间。
Background: Limited data are available regarding echocardiographic predictors for successful weaning from venoarterial (VA) extracorporeal membrane oxygenation (ECMO). We sought to determine whether echocardiographic parameters during ECMO flow study could predict successful weaning from ECMO.Methods: A total of 92 ECMO patients from a multicenter ECMO registry underwent VA-ECMO flow study with transthoracic echocardiography before a weaning trial. During VA-ECMO flow study, flow was decreased by 30%-50% of the initial flow for 15 minutes, and echocardiography was performed both at baseline and after flow reduction. Changes of echocardiographic parameters were compared between the successful and failed weaning group.Results: Sixty-four of the 92 patients were able to be weaned from VA-ECMO successfully. During VA-ECMO flow study, both lateral e' and tricuspid annular S' velocity improved significantly in the successful weaning group, while such findings were not observed in the failed weaning group. From univariable analysis, left heart decompression, improvement of lateral e' velocity, and improvement of tricuspid annular S' velocity showed significant association with successful VA-ECMO weaning. Predictability of the model with the change of lateral e' and tricuspid annular S' according to the reduction of ECMO flow for successful weaning from VA-ECMO is much higher than that of the model with conventional echocardiographic predictors from previous studies (left ventricular ejection fraction > 20%-25%, left ventricular time-velocity integral >= 10 cm, mitral annulus S' >= 6 cm/sec).Conclusions: Improvement of lateral e' velocity and tricuspid annular S' velocity during VA-ECMO flow study may better represent cardiac reserve from a recovering heart than conventional echocardiographic parameters at minimal flow. Assessment of tissue Doppler parameters during ECMO flow study is a simple and feasible method to guide physicians on the optimal time to wean from ECMO.