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Conference Paper: Flow manipulation and the association with myocardial contractility during extracorporeal life support (FLAME)

TitleFlow manipulation and the association with myocardial contractility during extracorporeal life support (FLAME)
Authors
Issue Date2021
PublisherOxford University Press. The Journal's web site is located at https://academic.oup.com/ehjacc
Citation
European Society of Cardiology (ESC) Acute CardioVascular Care (ACVC) Congress 2021, Virtual Congress, 13-14 March 2021. Abstract Book in European Heart Journal: Acute CardioVascular Care, 2021, v. 10 n. Suppl. 1, p. i34 How to Cite?
AbstractBackground: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an advanced technique in extracorporeal life support (ECLS) used to support extreme circulatory failure including patients with cardiac arrest and cardiogenic shock refractory to conventional support. It is a long-standing belief that peripheral V-A ECMO poses increased afterload to the inured heart, but conventional echocardiographic measurements are often insensitive in detecting subtle changes in loading conditions. Purpose: This study aimed to evaluate the effects of varying blood flow during peripheral V-A ECMO on intrinsic myocardial contractility, using detailed echocardiographic assessment including speckle tracking echocardiography (STE). Methods: Adult patients with acute cardiogenic shock who were supported by peripheral V-A ECMO from April 2019 to September 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram (TTE) within 48 hours after implementation of V-A ECMO, at different levels of extracorporeal blood flow – 100%, 120% and 50% of target blood flow (TBF). Results: A total of 30 patients were included. 22 (71%) were male, and the mean (SD) age was 54 (13) years. The major indications for V-A ECMO were myocardial infarction (19, 63% patients), and myocarditis (5, 17%). With a decrease in extracorporeal blood flow from 100% to 50% of TBF, mean arterial pressure (MAP) dropped from 76+/-3 to 64+/-3mmHg (p <0.001), and cardiac index (CI) increased from 0.89+/-0.13 to 1.27+/-0.18L/min/m2 (p < 0.001). All indices of left ventricular contractility improved at a lower extracorporeal blood flow: the myocardial contractility measured by global longitudinal peak systolic strain (GLPSS) improved from -3+/-0.7% to -5+/-0.8% (p < 0.001); left ventricular ejection fraction (LVEF) increased from 21.5+/-2.6% to 30.9+/-2.7% (p < 0.001) and 19.7+/-3.1% to 28.4+/-3.2% (p < 0.001) by biplane and linear methods, respectively; left ventricular index of myocardial performance (LIMP) improved from 1.51+/-0.12 to 1.03+/-0.09 (p < 0.001). Similar findings were reproduced when comparing left ventricular contractility at extracorporeal blood flows of 120% and 50% of TBF. Conclusions: The ECMO blood flow rate in peripheral V-A ECMO is inversely related to myocardial contractility, and is quantifiable by myocardial strain measured by STE.
DescriptionePoster Session 16.4.2: Nonpharmacological Treatment
Persistent Identifierhttp://hdl.handle.net/10722/306858
ISSN
2023 Impact Factor: 3.9
2023 SCImago Journal Rankings: 1.523

 

DC FieldValueLanguage
dc.contributor.authorMa, SKT-
dc.contributor.authorSin, WC-
dc.contributor.authorNgai, CW-
dc.contributor.authorWong, ASK-
dc.contributor.authorChan, YL-
dc.contributor.authorNg, PY-
dc.contributor.authorFang, S-
dc.contributor.authorTo, HM-
dc.contributor.authorYeoh, TH-
dc.contributor.authorTsai, NWP-
dc.contributor.authorTang, KYG-
dc.contributor.authorLau, LS-
dc.contributor.authorChan, WM-
dc.contributor.authorYeung, PNP-
dc.date.accessioned2021-10-22T07:40:36Z-
dc.date.available2021-10-22T07:40:36Z-
dc.date.issued2021-
dc.identifier.citationEuropean Society of Cardiology (ESC) Acute CardioVascular Care (ACVC) Congress 2021, Virtual Congress, 13-14 March 2021. Abstract Book in European Heart Journal: Acute CardioVascular Care, 2021, v. 10 n. Suppl. 1, p. i34-
dc.identifier.issn2048-8726-
dc.identifier.urihttp://hdl.handle.net/10722/306858-
dc.descriptionePoster Session 16.4.2: Nonpharmacological Treatment-
dc.description.abstractBackground: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an advanced technique in extracorporeal life support (ECLS) used to support extreme circulatory failure including patients with cardiac arrest and cardiogenic shock refractory to conventional support. It is a long-standing belief that peripheral V-A ECMO poses increased afterload to the inured heart, but conventional echocardiographic measurements are often insensitive in detecting subtle changes in loading conditions. Purpose: This study aimed to evaluate the effects of varying blood flow during peripheral V-A ECMO on intrinsic myocardial contractility, using detailed echocardiographic assessment including speckle tracking echocardiography (STE). Methods: Adult patients with acute cardiogenic shock who were supported by peripheral V-A ECMO from April 2019 to September 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram (TTE) within 48 hours after implementation of V-A ECMO, at different levels of extracorporeal blood flow – 100%, 120% and 50% of target blood flow (TBF). Results: A total of 30 patients were included. 22 (71%) were male, and the mean (SD) age was 54 (13) years. The major indications for V-A ECMO were myocardial infarction (19, 63% patients), and myocarditis (5, 17%). With a decrease in extracorporeal blood flow from 100% to 50% of TBF, mean arterial pressure (MAP) dropped from 76+/-3 to 64+/-3mmHg (p <0.001), and cardiac index (CI) increased from 0.89+/-0.13 to 1.27+/-0.18L/min/m2 (p < 0.001). All indices of left ventricular contractility improved at a lower extracorporeal blood flow: the myocardial contractility measured by global longitudinal peak systolic strain (GLPSS) improved from -3+/-0.7% to -5+/-0.8% (p < 0.001); left ventricular ejection fraction (LVEF) increased from 21.5+/-2.6% to 30.9+/-2.7% (p < 0.001) and 19.7+/-3.1% to 28.4+/-3.2% (p < 0.001) by biplane and linear methods, respectively; left ventricular index of myocardial performance (LIMP) improved from 1.51+/-0.12 to 1.03+/-0.09 (p < 0.001). Similar findings were reproduced when comparing left ventricular contractility at extracorporeal blood flows of 120% and 50% of TBF. Conclusions: The ECMO blood flow rate in peripheral V-A ECMO is inversely related to myocardial contractility, and is quantifiable by myocardial strain measured by STE.-
dc.languageeng-
dc.publisherOxford University Press. The Journal's web site is located at https://academic.oup.com/ehjacc-
dc.relation.ispartofEuropean Heart Journal: Acute CardioVascular Care-
dc.relation.ispartofESC Acute CardioVascular Care 2021-
dc.titleFlow manipulation and the association with myocardial contractility during extracorporeal life support (FLAME)-
dc.typeConference_Paper-
dc.identifier.emailSin, WC: drwcsin@hku.hk-
dc.identifier.emailTsai, NWP: nwtsai@hku.hk-
dc.identifier.emailChan, WM: drchanwm@hkucc.hku.hk-
dc.identifier.emailYeung, PNP: pyeungng@hku.hk-
dc.identifier.authoritySin, WC=rp02682-
dc.identifier.authorityYeung, PNP=rp02517-
dc.description.natureabstract-
dc.identifier.doi10.1093/ehjacc/zuab020.030-
dc.identifier.hkuros328585-
dc.identifier.volume10-
dc.identifier.issueSuppl. 1-
dc.identifier.spagei34-
dc.identifier.epagei34-
dc.publisher.placeUnited Kingdom-

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