title: Microcirculatory assessment of patients under VA-ECMO.
abstract: BACKGROUND
  Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective technique for providing emergency mechanical circulatory support for patients with cardiogenic shock. VA-ECMO enables a rapid restoration of global systemic organ perfusion, but it has not been found to always show a parallel improvement in the microcirculation. We hypothesized in this study that the response of the microcirculation to the initiation of VA-ECMO might identify patients with increased chances of intensive care unit (ICU) survival.
  
  
  METHODS
  Twenty-four patients were included in this study. Sublingual microcirculation measurements were performed using the CytoCam-IDF (incident dark field) imaging device. Microcirculatory measurements were performed at baseline, after VA-ECMO insertion (T1), 48-72 h after initiation of VA-ECMO (T2), 5-6 days after (T3), 9-10 days after (T4), and within 24 h of VA-ECMO removal.
  
  
  RESULTS
  Of the 24 patients included in the study population, 15 survived and 9 died while on VA-ECMO. There was no significant difference between the systemic global hemodynamic variables at initiation of VA-ECMO between the survivors and non-survivors. There was, however, a significant difference in the microcirculatory parameters of both small and large vessels at all time points between the survivors and non-survivors. Perfused vessel density (PVD) at baseline (survivor versus non-survivor, 19.21 versus 13.78 mm/mm2, p = 0.001) was able to predict ICU survival on initiation of VA-ECMO; the area under the receiver operating characteristic curve (ROC) was 0.908 (95 % confidence interval 0.772-1.0).
  
  
  CONCLUSIONS
  PVD of the sublingual microcirculation at initiation of VA-ECMO can be used to predict ICU mortality in patients with cardiogenic shock.
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. atila.kara@hacettepe.edu.tr.|Department of Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey. atila.kara@hacettepe.edu.tr.|Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Room H-603 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. atila.kara@hacettepe.edu.tr.
authors: Atila
authors: A
authors: Kara
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Sakir
authors: S
authors: Akin
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Dinis
authors: D
authors: Dos Reis Miranda
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Ard
authors: A
authors: Struijs
authors: Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Kadir
authors: K
authors: Caliskan
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Robert J
authors: RJ
authors: van Thiel
authors: Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Eric A
authors: EA
authors: Dubois
authors: Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Wouter
authors: W
authors: de Wilde
authors: Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Felix
authors: F
authors: Zijlstra
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Diederik
authors: D
authors: Gommers
authors: Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Can
authors: C
authors: Ince
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality* / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Cardiogenic shock; ICU; Microcirculation; Survival; VA-ECMO