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Sublingual Microcirculation in Temporary Mechanical Circulatory Support: A Current State of Knowledge
Zbigniew Putowski1, Michał P Pluta2, Natalia Rachfalska2
1University Clinical Center of the Medical University of Silesia in Katowice, Katowice, Poland.
Journal of Cardiothoracic and Vascular Anesthesia
|June 17, 2023
Summary
Mechanical circulatory support (MCS) may not improve microcirculatory blood flow in cardiogenic shock. This review explores MCS and microcirculation interactions, highlighting bedside assessment needs.
Area of Science:
- Cardiology
- Biomedical Engineering
- Critical Care Medicine
Background:
- Cardiogenic shock leads to microcirculatory hypoperfusion, impairing oxygen delivery and causing organ failure.
- Mechanical circulatory support (MCS) aims to restore end-organ perfusion but its microcirculatory effects are unclear.
- Assessing microcirculation at the bedside using vital microscopy is feasible but underutilized in MCS research.
Purpose of the Study:
- To review the interactions between mechanical circulatory support (MCS) and the microcirculation.
- To discuss existing research on microcirculatory assessment in patients receiving MCS.
- To highlight the need for further investigation into MCS's impact on capillary blood flow.
Main Methods:
- Review of literature on mechanical circulatory support and microcirculation.
- Discussion of bedside microcirculatory assessment techniques, specifically vital microscopy.
- Focus on sublingual microcirculation in the context of three MCS devices.
Main Results:
- Global hemodynamic improvements with MCS do not always translate to enhanced microcirculatory flow.
- Machine-blood interactions and complex hemodynamic effects complicate the interpretation of MCS efficacy.
- Limited research exists on direct microcirculatory assessment during MCS therapy.
Conclusions:
- Further research is needed to understand how different MCS devices affect microcirculatory function.
- Bedside microcirculatory assessment is crucial for optimizing MCS therapy in cardiogenic shock.
- Improved understanding of MCS-microcirculation interplay can enhance treatment strategies for cardiac failure.
