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Left ventricular dysfunction during extracorporeal membrane oxygenation in a hypoxemic swine model
1Department of Anesthesia, Children's Hospital and Medical Center, Seattle, Washington, USA.
The Annals of Thoracic Surgery
|March 28, 2001
Summary
Hypoxemic blood flow from the left ventricle during venoarterial extracorporeal membrane oxygenation (VA-ECMO) impairs cardiac function. This suggests VA-ECMO may not adequately oxygenate the heart muscle during respiratory support.
Area of Science:
- Cardiology
- Physiology
- Extracorporeal Membrane Oxygenation
Background:
- Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used for respiratory support.
- Coronary perfusion with hypoxemic blood from the left ventricle during VA-ECMO is a potential cause of myocardial dysfunction.
Purpose of the Study:
- To investigate the hypothesis that hypoxemic left ventricular output depresses myocardial function during VA-ECMO.
Main Methods:
- 10 piglets underwent VA-ECMO with induced left atrial hypoxemia (25-40 mm Hg).
- Left ventricular function was assessed using sonomicrometry and micromanometry.
- Measurements included peak LV pressure, shortening fraction, and preload recruitable dimensional stroke work.
Main Results:
- Left ventricular shortening fraction and velocity of circumferential fiber shortening significantly decreased.
- The preload recruitable dimensional stroke work slope was significantly lower, indicating reduced systolic function.
- End-systolic pressure-minor axis dimension relationship showed a trend towards decreased slope.
Conclusions:
- Hypoxemic cardiac output during VA-ECMO is linked to depressed left ventricular systolic function in this model.
- Current VA-ECMO practices may not ensure sufficient myocardial oxygenation.