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Experimental Venoarterial Extracorporeal Membrane Oxygenation Induces Left Ventricular Dysfunction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
2016 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 62, no 5, p. 518-524Article in journal (Refereed) Published
Abstract [en]

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has experienced an increased use in acute cardiac failure. There are some reports on negative effects of VA-ECMO on cardiac function, such as left ventricular (LV) dilatation and cardiac stun, but the support in the literature is scarce. This study investigates the effects of experimental VA-ECMO on LV function in both peripheral and central cannulation. Ten pigs were randomized to VA-ECMO by either peripheral cannulation through the femoral vessels or central cannulation in the right atrium and ascending aorta. Left ventricular performance was measured with pressure-volume catheters during 5 hours of VA-ECMO. The LV enddiastolic and end-systolic volumes increased comparably in both groups during ECMO. Left ventricular ejection fraction, stroke work, and maximum rate of pressure change decreased comparably in both groups as a function of time on ECMO. The site of cannulation had no impact on the LV response to ECMO. In conclusion, VA-ECMO increased LV volumes and reduced LV function, irrespective of cannulation site in this experimental model. Reduced LV ejection fraction and stroke work indicated LV dysfunction during ECMO.

Place, publisher, year, edition, pages
2016. Vol. 62, no 5, p. 518-524
Keywords [en]
extracorporeal membrane oxygenation, cannulation, left ventricle, left ventricular assist device
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-310680DOI: 10.1097/MAT.0000000000000392ISI: 000387874900006PubMedID: 27195745OAI: oai:DiVA.org:uu-310680DiVA, id: diva2:1062929
Available from: 2017-01-09 Created: 2016-12-19 Last updated: 2018-04-12Bibliographically approved
In thesis
1. Mechanical Circulatory Support in Left Ventricular Heart Failure
Open this publication in new window or tab >>Mechanical Circulatory Support in Left Ventricular Heart Failure
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Short-term mechanical circulatory support (MCS) with ventricular assist devices or veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the standard treatment in patients with cardiogenic shock unresponsive to pharmacological treatment. However, the haemodynamic effects of these devices are not yet fully described, nor are their effects on ventricular function and myocardial recovery.

The aims of this thesis are to increase knowledge of the haemodynamic changes during MCS in different settings and to provide new insights into how MCS therapy should be guided in the specific patient.

In Studies I and II, we developed experimental animal models to investigate the effect of VA ECMO on left ventricular (LV) performance and size of myocardial infarction in different cannulation strategies. In Study I, we found that the LV performance was negatively affected by VA ECMO in both centrally and peripherally cannulated animals. In Study II, we specifically studied the effect of VA ECMO with and without the addition of LV drainage on the size of experimentally induced myocardial infarction. The results showed that active LV decompression had no effect on infarct size in the acute setting.

Studies III and IV are retrospective studies on patients in cardiogenic shock treated with short-term mechanical support with either Impella® (Studies III and IV) or VA ECMO (Study IV). In Study IV, we concluded that treatment with Impella® has excellent effects on haemodynamic parameters and an acceptable mortality and complication rate. The studied pre-implantation patient parameters did not significantly affect outcome. In Study IV, we compared the outcome of patients treated with Impella® with those treated with VA ECMO. After adjustment for pre-implantation patient status, as defined by SAVE score, no difference in short- or long-term mortality was seen between the two groups.

In conclusion, VA ECMO, whether central or peripheral, negatively affects the LV, and the addition of a LV drain has no effect on infarct size in these experimental models. Both Impella® and VA ECMO offer good haemodynamic results with acceptable mortality and complication rates in patients with refractory cardiogenic shock. When adjusted for the SAVE score, the outcomes of both treatment modalities are comparable.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 68
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1464
Keywords
Mechanical Circulatory Support, Left Ventricular Heart Failure, Left Ventricular Assist Device, Extracorporeal Membrane Oxygenation, ECMO
National Category
Surgery Cardiac and Cardiovascular Systems
Research subject
Thorax Surgery
Identifiers
urn:nbn:se:uu:diva-347427 (URN)978-91-513-0330-7 (ISBN)
Public defence
2018-06-06, Enghoffsalen, Ingång 50 bv, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-05-14 Created: 2018-04-12 Last updated: 2018-10-08

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Schiller, PetterVikholm, PerHellgren, Laila

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