%A Wei,Tzu-Jung %A Wang,Chih-Hsien %A Chan,Wing-Sum %A Huang,Chi-Hsiang %A Lai,Chien-Heng %A Wang,Ming-Jiuh %A Chen,Yih-Sharng %A Ince,Can %A Lin,Tzu-Yu %A Yeh,Yu-Chang %D 2021 %J Frontiers in Medicine %C %F %G English %K Microcirculation,Extracorporeal Membrane Oxygenation,Hemodynamics,Cardiogenic shock,Critical Care %Q %R 10.3389/fmed.2021.649263 %W %L %M %P %7 %8 2021-April-07 %9 Original Research %# %! Microcirculatory response in ECMO %* %< %T Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study %U https://www.frontiersin.org/articles/10.3389/fmed.2021.649263 %V 8 %0 JOURNAL ARTICLE %@ 2296-858X %X Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining organ perfusion in patients with cardiogenic shock, but VA-ECMO pump flow optimization remains as a clinical challenge. This study aimed to investigate the response of sublingual microcirculation to changes in VA-ECMO pump flow.Methods: Sublingual microcirculation was measured before and after changing VA-ECMO pump flow according to the treatment plan of ECMO team within 24 h and at 24-48 h after VA-ECMO placement. In clinical events of increasing VA-ECMO pump flow, those events with increased perfused vessel density (PVD) were grouped into group A, and the others were grouped into group B. In clinical events of decreasing VA-ECMO pump flow, those events with increased PVD were grouped into group C, and the others were grouped into group D.Results: Increased PVD was observed in 60% (95% CI, 38.5–81.5%) of the events with increasing VA-ECMO pump flow. The probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm2 at baseline than those with a PVD ≥ 15 mm/mm2 [100% (95% CI, 54.1–100%) vs. 42.9% (95% CI, 17.7–71.1%), P = 0.042]. Other microcirculatory and hemodynamic parameters at baseline did not differ significantly between group A and B or between group C and D.Conclusion: This study revealed contradictory and non-contradictory responses of sublingual microcirculation to changes in VA-ECMO pump flow. Tandem measurements of microcirculation before and after changing VA-ECMO pump flow may help to ensure a good microcirculation.