Investigation of microcirculation in patients with venoarterial extracorporeal membrane oxygenation life support

Abstract

Microcirculatory dysfunction has been observed in patients who have suffered septic shock or cardiogenic shock, and in patients who have undergone surgery [5–9]. [...]microcirculatory dysfunction is associated with poor prognosis in patients with severe sepsis and in patients who have suffered an out-of-hospital cardiac arrest [10–12]. Because information regarding the association between microcirculatory dysfunction and prognosis in patients with VA-ECMO support is limited [13], this study focused on comparing perfused small vessel density (PSVD) between 28-day nonsurvivors and survivors by visualizing their microcirculation using a third-generation video microscope within 12 h after VA-ECMO placement [14, 15]. According to the suggestions of a previously held roundtable conference for evaluating the microcirculation [20], the following parameters were investigated: a) total small vessel (less than 20 μm) density (TSVD); b) perfused small vessel density (PSVD); c) proportion of perfused vessels (PPV); d) microvascular flow index (MFI) score; and e) heterogeneity index (HI). According to the ROC curve analysis, the threshold values of the APACHE II score, lactate level, PSVD, and PPV were 22.5, 7.5 mmol/l, 16.2 mm/mm2, and 76.5%, respectively.