Abstract | BACKGROUND: METHODS: Thirty-seven patients receiving VA-ECMO for cardiogenic shock via axillary or femoral artery cannulation were prospectively enrolled. Measured bilateral middle cerebral artery (MCA), mean flow velocities (MFV), and pulsatility indices (PI) were the primary outcomes and adverse neurologic events were secondary outcomes. RESULTS: The median age was 58 years (IQR 51-66) with 26 (70%) males. Median VA-ECMO flow was 3.8 L/min (IQR 3.2-4.9) with mean arterial pressures of 80 mm Hg (IQR 75-86). Nineteen patients received right axillary artery cannulation while 18 underwent femoral cannulation. Compared with the femoral group, MFV was higher in the axillary group in the right MCA (46 cm/s [IQR 26-57] vs 27 [17-36], P = 0.03) and left (43 [IQR 35-60] vs 29 cm/s [16-48], P = 0.05). Axillary PI was significantly lower compared with the femoral group (right: 0.48 cm/s [0.25-0.65] vs 0.83 [0.66-0.93], P = 0.02; left: 0.41 cm/s [0.29-0.63] vs 1.02 [0.7-1.3], P = 0.004). One axillary patient experienced a stroke with deficits. CONCLUSIONS: TCD appears to be an effective tool for indirect monitoring of CBF in patients with ECMO with limited pulsatility. Axillary artery cannulation seems to provide higher cerebral flow rates without any difference in neurologic outcomes. Future studies may incorporate TCD into regulating ECMO flows to achieve physiologic CBF.
|
Authors | Michael Salna, Hirohisa Ikegami, Joshua Z Willey, Arthur R Garan, Marisa Cevasco, Christine Chan, Hiroo Takayama, Paolo C Colombo, Yoshifumi Naka, Koji Takeda |
Journal | Journal of cardiac surgery
(J Card Surg)
Vol. 34
Issue 6
Pg. 447-452
(Jun 2019)
ISSN: 1540-8191 [Electronic] United States |
PMID | 31058374
(Publication Type: Journal Article)
|
Copyright | © 2019 Wiley Periodicals, Inc. |
Topics |
- Aged
- Axillary Artery
- Blood Flow Velocity
- Catheterization, Peripheral
(adverse effects, methods)
- Cerebrovascular Circulation
(physiology)
- Extracorporeal Membrane Oxygenation
(adverse effects, methods)
- Female
- Femoral Artery
- Humans
- Male
- Middle Aged
- Monitoring, Physiologic
(methods)
- Shock, Cardiogenic
(physiopathology, therapy)
- Ultrasonography, Doppler
(methods)
|