%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.