Abstract
BackgroundTemporary circulatory support is a bridge between acute circulatory failure and definitive treatment or recovery. Currently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is considered to be one of the effective circulatory support methods, although cardiac function monitoring during the treatment still needs further investigation. Inflection point of arterial oxygen partial pressure (IPPaO2) may occur at an early stage in part of patients with a good prognosis after VA-ECMO treatment, and the relationship between time of IPPaO2 (tIPPaO2) and recovery of cardiac function or prognosis remains unclear.MethodsTo investigate this relationship, we retrospectively analyzed the clinical data of 71 patients with different conditions after treatment with VA-ECMO in the emergency center of Jiangsu Province Hospital between May 2015 and July 2020. Spearman’s correlation analysis was used for the correlation between tIPPaO2 and quantitative data, and ROC curve for the predictive effect of tIPPaO2 on the 28-day mortality.ResultsThirty-five patients were admitted because of refractory cardiogenic shock (26 of 35 survived) and the remaining 36 patients due to cardiac arrest (13 of 36 survived). The overall survival rate was 54.9% (39 of 71 survived). Acute physiology and chronic health evaluation II, ECMO time, tIPPaO2, continuous renal replacement therapy time, mechanical ventilation time, and bleeding complications in the survival group were lower than those in the non-survival group, with length of stay, intensive care unit stay, and platelet levels were being higher. The tIPPaO2 was negatively correlated with ejection fraction, and the shorter tIPPaO2 resulted in a higher 28-day survival probability, higher predictive value for acute myocardial infarction and fulminant myocarditis.ConclusionsTherefore, tIPPaO2 could be a reliable qualitative indicator of cardiac function in patients treated with VA-ECMO, which can reveal appropriate timing for adjusting VA-ECMO flow or weaning.Trial registrationChiCTR1900026105.
Highlights
Acute circulatory failure (ACF) is a commonly occurring acute severe syndrome in the emergency department
Multiple causes, including myocardial infarction (AMI), fulminant myocarditis (FMC), sepsis-associated cardiomyopathy (SACM), and cardiotoxic drug poisoning, can lead to ACF, which is often manifested as refractory cardiogenic shock (RCS) or even cardiac arrest (CA) [1, 2]
Patient characteristics We collected the clinical data of 92 patients, of which 21 were excluded because their ECMO support time was ≤72 h (n = 9), mode changed from VA to VAV during ECMO (n = 3), data were incomplete (n = 7), and past cardiac disease affected Ejection fraction (EF) (n = 2)
Summary
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used for the salvage treatment of ACF because it can be percutaneously performed quickly at bedside, thereby rapidly providing oxygenated blood with a stable flow rate for cardiopulmonary replacement until definitive treatment or recovery of cardiac function [1,2,3,4,5]. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is considered to be one of the effective circulatory support methods, cardiac function monitoring during the treatment still needs further investigation. Inflection point of arterial oxygen partial pressure (IPPaO2) may occur at an early stage in part of patients with a good prognosis after VA-ECMO treatment, and the relationship between time of IPPaO2 (tIPPaO2) and recovery of cardiac function or prognosis remains unclear
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