Left ventricular physiological effects of veno-arterial ECMO support during cardiogenic shock

心源性休克时静脉-动脉 ECMO 支持的左心室生理效应

• 批准号: 10668465
• 负责人: Demetris Yannopoulos
• 金额: $ 64.82万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-08-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668465
• 关键词: Affect; Angiography; Animal Model; Area; Artificial Heart; Assisted Circulation; Cannulations; Cardiac; Cardiac Catheterization Procedures; Cardiogenic Shock; Cessation of life; Chronic; Clinical; Clinical Data; Critical Illness; Data; Deterioration; Development; Diameter; Disadvantaged; EFRAC; Echocardiography; Energy Metabolism; Environment; Evolution; Extracorporeal Membrane Oxygenation; Goals; Heart; Heart Arrest; Heart-Assist Devices; Hospital Mortality; Hospitalization; Iatrogenesis; Image; Institution; Laboratories; Left; Left Ventricular Dysfunction; Left ventricular structure; Lung; Mechanics; Methods; Morbidity - disease rate; Myocardial; Neurologic; Organ; Outcomes Research; Oxygen Consumption; Patient-Focused Outcomes; Patients; Pattern; Performance; Physiologic intraventricular pressure; Physiological; Population; Publishing; Recovery; Research; Research Project Grants; Research Proposals; Right Ventricular Function; Self-Help Devices; Shock; Stress; Stroke; Testing; Time; Transplantation; Uncertainty; Ventricular; Work; Workload; acute coronary syndrome; animal data; artificial lung; cost; experience; hemodynamics; human data; hypoperfusion; improved; mortality; out-of-hospital cardiac arrest; patient population; pressure; reconstruction; respiratory; right ventricular failure

Project Summary/Abstract Cardiogenic shock is a devastating problem that has had a relatively stagnant in-hospital mortality around 30-40% in the last decade. Consequently, an array of mechanical support strategies has emerged to mitigate the multi-organ hypoperfusion. Among them, percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used to treat cardiogenic shock due to its capacity to be instituted rapidly in the cardiac catheterization laboratory and provide large volume complete hemodynamic and respiratory support. However, this strategy has notable disadvantages, namely high cost associated with its programmatic development and the potential for introducing iatrogenic complications in a very sick population. Prior invasive hemodynamic data from animal models have suggested that there is deterioration of LV performance due to increased stroke work within minutes of the commencement of VA-ECMO hemodynamic support. There is also observational clinical data showing that LV distension may worsen with VA-ECMO support. Conversely, human data from our group’s prior experience have suggested that VA-ECMO support in patients with minimal pulsatility after out-of-hospital cardiac arrest can dramatically improve cardiac recovery and rates of neurologically favorable survival. These conflicting data have led to the emergence of diverse management strategies including VA-ECMO in patients with cardiogenic shock either due to AMI or cardiac arrest. In the context of the rapidly increasing usage of VA-ECMO usage there is a critical need to identify the manner in which VA-ECMO affects cardiac hemodynamics in the setting of cardiogenic shock. To that goal we will pursue the following specific aims: 1. Define the LV pressure volume area (PVA) and stroke work at different levels of VA-ECMO support in patients cannulated for CS. 2. Define the temporal changes of LV stroke work with prolonged VA-ECMO support over the course of the hospitalization. The temporal recovery patterns will be associated with clinical hard endpoints of decannulation or transition to permanent cardiac assist devices/transplant or death. 3.Validate the accuracy of non-invasive reconstruction of PV-loops compared to invasively collected data to help establish an easier way to assess LV stroke work for every day practice. The expected outcome of this research proposal is to define the physiologic effect of VA-ECMO support on the left ventricle energetics and provide objective scientific clinical proof derived from a high mortality and morbidity patient population. Additionally, we expect that our data will be useful to establish normative hemodynamic and imaging principles and strategies for assessing patients on VA-ECMO.

项目摘要/摘要 心源性休克是一个毁灭性的问题，周围存在相对停滞的院内死亡率 过去十年中的30-40％。因此，已经出现了一系列机械支持策略以减轻 多器官灌注不足。其中，经皮静脉静脉外膜 氧合（VA-ECMO）越来越多地用于治疗心源性休克，因为它的能力是 在心脏导管实验室中迅速建立，并提供大量的完整血流动力学 和呼吸支持。但是，这种策略具有明显的疾病，即与 它的编程发展及其在非常病的生病中引入息护物并发症的潜力 人口。 先前来自动物模型的侵入性血流动力学数据表明LV存在延迟 VA-ECMO血流动力学开始后的几分钟内，由于中风工作增加而导致的表现 也有观察性的临床数据表明，VA-ECMO的LV延伸可能会更糟 支持。相反，我们小组先前经验的人类数据表明，VA-ECMO支持 院外心脏骤停后搏动性最小的患者可显着改善心脏恢复 和神经学有利的生存率。 这些相互矛盾的数据导致了潜水员管理策略的出现，包括va-ecmo 由于AMI或心脏骤停引起的心脏病性休克患者。在迅速增加的背景下 使用VA-ECMO的使用情况是确定VA-ECMO影响心脏的迫切需要 在心脏病休克的环境中的血液动力学。 为此，我们将追求以下特定目标： 1。在不同级别的VA-ECMO支持中定义LV压力量面积（PVA）和中风工作 患者插入了CS。 2。定义长时间的VA-ECMO的LV中风工作的暂时变化 在整个住院期间的支持。临时恢复模式将与临床有关 变形或过渡到永久心脏辅助设备/移植或死亡的硬端点。 3.与侵入性收集的数据相比，PV环的非侵入性重建的准确性 帮助建立一种评估每天练习的LV中风工作的简便方法。 该研究建议的预期结果是定义VA-ECMO支持对 左心室能量学，并提供了来自高死亡率的客观科学临床证明 发病率患者人数。此外，我们希望我们的数据建立正常 血液动力学和成像原理以及评估VA-ECMO患者的策略。

项目成果

Case Report: Correlation between pulmonary capillary wedge pressure and left-ventricular diastolic pressure during treatment with veno-arterial extracorporeal membrane oxygenation.

• DOI: 10.3389/fcvm.2023.1271227
• 发表时间: 2023
• 期刊: FRONTIERS IN CARDIOVASCULAR MEDICINE
• 影响因子: 3.6
• 作者: Kalra, Rajat;Gaisendrees, Christopher;Alexy, Tamas;Kosmopoulos, Marinos;Jaeger, Deborah;Schlachtenberger, Georg;Raveendran, Ganesh;Bartos, Jason A.;Bernal, Alejandra Gutierrez;John, Ranjit;Wahlers, Thorsten;Yannopoulos, Demetris
• 通讯作者: Yannopoulos, Demetris