Quantitative evaluation of hemodynamic parameters by echocardiography in
patients with postcardiotomy cardiac shock supported by extracorporeal
membrane oxygenation
Abstract
Objective: To investigate the value of echocardiography in monitoring
hemodynamics of postcardiotomy cardiac shock (PCS) patients before,
during, and after weaning from extracorporeal membrane oxygenation
(ECMO). Methods: Fifty-two patients were divided into a successful
weaning group (Group A, n=23) and non-successful group (Group B, n=29).
Hemodynamic parameters measured by echocardiography were collected
before, during, and after ECMO. The intra-group changes and inter-group
differences were analyzed. Results: In group A, the central venous
pressure (CVP), proximal right ventricular outflow tract (RVOT),
tricuspid annular plane systolic excursion (TAPSE), velocity of
tricuspid valve (TVDV), and systolic velocity of tricuspid annulus
(s‘TV) during EMCO were significantly lower than before ECMO. After
ECMO, left ventricular ejection fraction (LVEF), systolic velocity of
mitral annulus (s‘MV), and velocity-time integral of LV outflow tract
(LVOT-VTI) were higher than pre-ECMO, and CVP, LVEF, s‘MV, LVOT-VTI,
RVOT, TAPSE, TVDV and s‘TV were higher than during ECMO (all
p<0.05). In group B, compared to pre-ECMO, subjects exhibited
decreased CVP, RVOT, TAPSE, TVDV and s‘TV during ECMO. TAPSE, TVDV, and
s‘TV were continuously lower after ECMO, while CVP and RVOT became
higher after ECMO (all p<0.05). After ECMO, LVEF, s‘MV,
LVOT-VTI, TAPSE, TVDV and s‘TV in group A were higher than those in
group B (all p<0.05). Multiple logistic regression analysis
showed that LVEF (OR=1.387, 95%CI: 1.072-1.793, p=0.013) and Tei index
(OR=-0.005, 95% CI: 0.000-0.939, p=0.047) were independent factors
related to the successfulness of ECMO weaning. Conclusions: Quantitative
assessment of both LV and RV by echocardiography is important for ECMO
weaning.