title: Effect of increasing mean arterial blood pressure on microcirculation in patients with cardiogenic shock supported by extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support.
  
  
  METHODS
  A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out. Patients with MAP <60 mmHg treated with ECMO support were the study cohort. Inotropic and vasopressor agents (dopamine, dobutamine, norepinephrine or epinephrine) were administered to maintain the MAP at 60-90 mmHg. Hemodynamic and microcirculatory data were obtained at a baseline MAP of <60 mmHg and 1 h after target MAP was reached. As parameters of microcirculation, we measured thenar eminence tissue oxygenation (StO2) and its change during the vessel obstruction test and cerebral tissue oxygenation (rSO2) with near-infrared spectroscopy.
  
  
  RESULTS
  Seventeen patients were enrolled in the study. MAP of all patients increased and reached predefined therapeutic targets (52 [50-54.5] vs.74 [70-78.5] mmHg; p < 0.001). To obtain these targets, doses of inotropic agents were increased (inotrope score increased from 14 [15.5-28] μg/kg/min; p < 0.001). No obvious changes were observed in thenarmuscleStO2 and cerebral rSO2. Thenar muscle StO2 desaturation slope and resaturation slopes during the vessel obstruction test were also unchanged.
  
  
  CONCLUSIONS
  Increasing MAP from <60 mmHg to 60-90 mmHg did not affect microcirculation variables in cardiogenic-shock patients with ECMO support.
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Zhongtao
authors.initials: Z
authors.lastname: Du
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Zaishen
authors.initials: Z
authors.lastname: Jia
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Jinhong
authors.initials: J
authors.lastname: Wang
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Zhichen
authors.initials: Z
authors.lastname: Xing
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Chunjing
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Xiaofang
authors.initials: X
authors.lastname: Yang
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Yang
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Na
authors.initials: N
authors.lastname: Miao
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Jialin
authors.initials: J
authors.lastname: Xing
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Ming
authors.initials: M
authors.lastname: Jia
authors.affiliation: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
authors.forename: Xiaotong
authors.initials: X
authors.lastname: Hou
mesh_terms: D062186:Arterial Pressure / Q000502:physiology*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000473:pathology / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000494:pharmacology
chemical_list: D014662:Vasoconstrictor Agents
keywords: Cardiogenic shock; extracorporeal membrane oxygenation; hemodynamics; inotropic agents; microcirculation