Microcirculatory Perfusion Disturbances During Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review.

IF 1.9 4区 医学 Q3 HEMATOLOGY Microcirculation Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI:10.1111/micc.12891
Carolien Volleman, S Jorinde Raasveld, Faridi S Jamaludin, Alexander P J Vlaar, Charissa E van den Brom
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Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used in case of potentially reversible cardiac failure and restores systemic hemodynamics. However, whether this is followed by improvement of microcirculatory perfusion is unknown. Moreover, critically ill patients have possible pre-existing microcirculatory perfusion disturbances. Therefore, this review provides an overview of alterations in sublingual microcirculatory perfusion in critically ill adult patients receiving VA-ECMO support. Pubmed, Embase (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched according to PRISMA guidelines. Studies reporting sublingual microcirculatory perfusion measurements in adult patients supported by VA-ECMO were included. Outcome parameters included small vessel density (SVD), perfused vessel density (PVD), perfused small vessel density (PSVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) and the heterogeneity index (HI). The protocol was registered at PROSPERO (CRD42021243930). The search identified 1215 studies of which 11 were included. Cardiogenic shock was the most common indication for VA-ECMO (n=8). Three studies report increased PSVD, PPV, and MFI 24 hours after initiation of ECMO compared to pre-ECMO. Nonetheless, microcirculatory perfusion stabilized thereafter. Four out of four studies showed higher PSVD and PPV in survivors compared to non-survivors. Over time, survivors showed recovery of microcirculatory perfusion within hours of initiation of ECMO, whereas this was absent in non-survivors. Notwithstanding the limited sample, VA-ECMO seems to improve microcirculatory perfusion shortly after initiation of ECMO, especially in survivors. Further research in larger cohorts is needed to clarify the longitudinal effects of ECMO on microcirculatory perfusion.

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静脉-动脉体外膜氧合过程中的微循环灌注紊乱:系统回顾。
静脉-动脉体外膜肺氧合(VA-ECMO)用于潜在可逆性心力衰竭,可恢复全身血液动力学。然而,微循环灌注是否会随之改善尚不清楚。此外,重症患者可能已经存在微循环灌注障碍。因此,本综述概述了接受 VA-ECMO 支持的重症成人患者舌下微循环灌注的改变。根据 PRISMA 指南对 Pubmed、Embase (Ovid)、Cochrane Central Register of Controlled Trials 和 Web of Science 进行了系统检索。结果参数包括小血管密度(special vessel density)、血管密度(special vessel density)、血管密度(special vessel density)、血管密度(special vessel density)和血管密度(special vessel density)。结果参数包括小血管密度(SVD)、灌注血管密度(PVD)、灌注小血管密度(PSVD)、灌注血管比例(PPV)、微血管流量指数(MFI)和异质性指数(HI)。研究方案已在 PROSPERO(CRD42021243930)上注册。搜索发现了 1215 项研究,其中 11 项被纳入。心源性休克是 VA-ECMO 最常见的适应症(8 项)。三项研究报告称,与 ECMO 前相比,ECMO 启动 24 小时后 PSVD、PPV 和 MFI 均有所增加。尽管如此,微循环灌注随后趋于稳定。四项研究中有四项显示,与非幸存者相比,幸存者的 PSVD 和 PPV 较高。随着时间的推移,幸存者在启动 ECMO 后数小时内微循环灌注恢复,而非幸存者则没有这种情况。尽管样本有限,但 VA-ECMO 似乎在启动 ECMO 后不久就能改善微循环灌注,尤其是在幸存者中。需要在更大的队列中开展进一步研究,以明确 ECMO 对微循环灌注的纵向影响。
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来源期刊
Microcirculation
Microcirculation 医学-外周血管病
CiteScore
5.00
自引率
4.20%
发文量
43
审稿时长
6-12 weeks
期刊介绍: The journal features original contributions that are the result of investigations contributing significant new information relating to the vascular and lymphatic microcirculation addressed at the intact animal, organ, cellular, or molecular level. Papers describe applications of the methods of physiology, biophysics, bioengineering, genetics, cell biology, biochemistry, and molecular biology to problems in microcirculation. Microcirculation also publishes state-of-the-art reviews that address frontier areas or new advances in technology in the fields of microcirculatory disease and function. Specific areas of interest include: Angiogenesis, growth and remodeling; Transport and exchange of gasses and solutes; Rheology and biorheology; Endothelial cell biology and metabolism; Interactions between endothelium, smooth muscle, parenchymal cells, leukocytes and platelets; Regulation of vasomotor tone; and Microvascular structures, imaging and morphometry. Papers also describe innovations in experimental techniques and instrumentation for studying all aspects of microcirculatory structure and function.
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