Effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain

Pauline Yeung Ng; Tammy Sin Kwan Ma; April Ip; Shu Fang; Andy Chak Cheung Li; Alfred Sai Kuen Wong; Chun Wai Ngai; Wai Ming Chan; Wai Ching Sin

doi:10.3389/fcvm.2023.1147783

Effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain

Front Cardiovasc Med. 2023 Apr 12:10:1147783. doi: 10.3389/fcvm.2023.1147783. eCollection 2023.

Authors

Affiliations

¹ Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
² Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China.
³ Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.

Abstract

Background: We evaluated the effects of varying blood flow rate during peripheral veno-arterial extracorporeal membrane oxygen (V-A ECMO) on left ventricular function measured by two-dimensional strain.

Methods: Adult patients who were supported by peripheral V-A ECMO were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram within the first 48 h after implementation of V-A ECMO. Measurements at 100%, 120%, and 50% of target blood flow (TBF) were compared.

Results: A total of 54 patients were included and the main indications for V-A ECMO were myocardial infarction [32 (59.3%)] and myocarditis [6 (11.1%)]. With extracorporeal blood flow at 50% compared with 100% TBF, the mean arterial pressure was lower [66 ± 19 vs. 75 ± 18 mmHg, p < 0.001], stroke volume was greater [23 (12-34) vs. 15 (8-26) ml, p < 0.001], and cardiac index was higher [1.2 (0.7-1.7) vs. 0.8 (0.5-1.3) L/min/m², p < 0.001]. Left ventricular contractile function measured by global longitudinal strain improved at 50% compared with 100% TBF [-2.8 (-7.6- -0.1) vs. -1.2 (-5.2-0) %, p < 0.001]. Similarly, left ventricular ejection fraction increased [24.4 (15.8-35.5) vs. 16.7 (10.0-28.5) %, p < 0.001] and left ventricular outflow tract velocity time integral increased [7.7 (3.8-11.4) vs. 4.8 (2.5-8.5) cm, p < 0.001]. Adding echocardiographic parameters of left ventricular systolic function to the Survival After Veno-arterial ECMO (SAVE) score had better discriminatory value in predicting eventual hospital mortality (AUROC 0.69, 95% CI 0.55-0.84, p = 0.008) and successful weaning from V-A ECMO (AUROC 0.68, 95% CI 0.53-0.83, p = 0.017).

Conclusion: In the initial period of V-A ECMO support, measures of left ventricular function including left ventricular ejection fraction and global longitudinal strain were inversely related to ECMO blood flow rate. Understanding the heart-ECMO interaction is vital to interpretation of echocardiographic measures of the left ventricle while on ECMO.

Keywords: cardiogenic shock; extracorporeal membrane oxygenation; myocardial strain; speckle tracking echocardiography; target blood flow; transthoracic echocardiography.

Grants and funding

This work was supported by the New Staff Start-Up Scheme of The University of Hong Kong, and an unrestricted philanthropic donation from Mr and Mrs Laurence Tse.