Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters. Weaning was performed by decreasing the VA-ECMO flow to 50% (F50) from the baseline. The endpoint of the study was successful VA-ECMO explantation within 48 hours after weaning. The response of sublingual microcirculation to a weaning attempt (WA) was evaluated. Microcirculation was measured in one sublingual area (single spot (ss)) using CytoCam IDF imaging during WA. Total vessel density (TVDss) and perfused vessel density (PVDss) of the sublingual area were evaluated before and during 50% flow reduction (TVDssF50, PVDssF50) after a WA and compared to conventional echocardiographic parameters as indicators of the success or failure of the WA. Patients (n = 13) aged 49 ± 18 years, who received VA-ECMO for the treatment of refractory CS due to pulmonary embolism (n = 5), post cardiotomy (n = 3), acute coronary syndrome (n = 2), myocarditis (n = 2) and drug intoxication (n = 1), were included. TVDssF50 (21.9 vs 12.9 mm/mm(2), p = 0.001), PVDssF50 (19.7 vs 12.4 mm/mm(2), p = 0.01) and aortic velocity-time integral (VTI) at 50% flow reduction (VTIF50) were higher in patients successfully weaned vs not successfully weaned. The area under the curve (AUC) was 0.99 vs 0.93 vs 0.85 for TVDssF50 (small vessels) >12.2 mm/mm(2), left ventricular ejection fraction (LVEF) >15% and aortic VTI >11 cm. Likewise, the AUC was 0.91 vs 0.93 vs 0.85 for the PVDssF50 (all vessels) >14.8 mm/mm(2), LVEF >15% and aortic VTI >11 cm. This study identified sublingual microcirculation as a novel potential marker for identifying successful weaning from VA-ECMO. Sustained values of TVDssF50 and PVDssF50 were found to be specific and sensitive indicators of successful weaning from VA-ECMO as compared to echocardiographic parameters
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机译:静脉动脉体外膜氧合(VA-ECMO)越来越多地用于心源性休克(CS)的治疗。然而,成功断奶的标志仍然未知。我们的假设是,成功断奶与ECMO血流减少期间持续的微循环功能有关。因此,我们试图通过使用入射暗场(IDF)成像来评估从VA-ECMO的成功断奶,并使用超声心动图参数比较IDF成像来测试同一舌下部位微循环成像的有用性。通过将VA-ECMO流量从基线降低到50%(F50)来执行断奶。研究的终点是在断奶后48小时内成功进行VA-ECMO移植。评估了舌下微循环对断奶尝试(WA)的反应。在WA期间使用CytoCam IDF成像在一个舌下区域(单点)测量微循环。在WA后50%流量减少之前和期间(TVDssF50,PVDssF50)评估舌下区域的总血管密度(TVDss)和灌注血管密度(PVDss),并与常规超声心动图参数进行比较,以作为WA成功或失败的指标。年龄在49±±18岁的患者(n = years13),因肺栓塞(n for = 5),心脏切开术后(n = 3),急性冠脉综合征(n = 2)而接受VA-ECMO治疗难治性CS包括心肌炎(n = 2)和药物中毒(n = 1)。 TVDssF50(21.9 vs 12.9 mm / mm(2),p = 0.001),PVDssF50(19.7 vs 12.4 mm / mm(2),p = 0.01)和主动脉速度-时间积分(VTI),流量减少50%(VTIF50)成功断奶的患者比未成功断奶的患者高。对于TVDssF50(小血管)> 12.2 mm / mm(2),左心室射血分数(LVEF)> 15%和主动脉VTI> 11 cm,曲线下面积(AUC)为0.99 vs 0.93 vs 0.85。同样,PVDssF50(所有血管)> 14.8 mm / mm(2),LVEF> 15%和主动脉VTI> 11 cm的AUC为0.91 vs.0.93 vs 0.85。这项研究确定舌下微循环是从VA-ECMO中成功断奶的新型潜在标志物。与超声心动图参数相比,TVDssF50和PVDssF50的持续值是成功退出VA-ECMO的特异性和敏感指标
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