Extracorporeal Membrane Oxygenation
Conditions
Keywords
pulmonary artery catheter, echocardiography, fluid responsiveness, extracorporeal membrane oxygenation
Brief summary
Objective： 1. To evaluate the consistency of cardiac output measured by different hemodynamic monitoring methods in patients with VA-ECMO 2. To evaluate whether different hemodynamic monitoring methods can accurately detect the trend of cardiac output changes
Detailed description
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used for profound cardiogenic shock to bridge to decision,ventricular assist devices,or transplant.Close monitoring of cardiac output, especially in patients before and after intervention (such as volume expansion, diuresis, vasoconstriction, vasodilation therapy), can help to adjust the treatment strategy. Hemodynamic monitoring in ECMO patients requires familiarity with the underlying pathophysiology and circulatory mechanics of extracorporeal flow.Limited to the actual clinical situation of patients, one or two hemodynamic monitoring methods may be accepted. Is there consistency between different hemodynamic monitoring results? And whether hemodynamic monitoring can accurately detect the changes of these parameters before and after intervention is an important issue in clinical practice. This study will provide important reference for VA-ECMO patients how to choose appropriate hemodynamic monitoring tools and how to interpret the results of hemodynamic monitoring.
Interventions
DIAGNOSTIC_TESTTrendelenburg Maneuver
In the Trendelenburg position, the body is laid supine with the feet higher than the head by 15-30 degrees. The venous return increases in the trendelenburg position which in turn increases the stroke volume.
DIAGNOSTIC_TESTdobutamine stress test
Dobutamine was infused intravenously at the initial dose of 2.5 ug/kg/min. Echocardiography was performed after 5-10 minutes of continuous infusion, and hemodynamic data were recorded.
Sponsors
Shanghai Zhongshan Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. cardiac surgery 2. treatment with VA-ECMO 3. mechanical ventilation 4. hemodynamic monitoring according to patient's condition (PAC, Flotrac, echocardiography)
Exclusion criteria
1. age \< 18 2. cardiac arrhythmia 3. moderate to severe aortic, mitral and tricuspid regurgitation 4. active hemorrhage 5. IABP 6. spontaneous triggering of the ventilator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Baseline Cardiac Output measurement | within1 minute at baseline position | Cardiac Output measured at baseline position（ in a supine position with the head elevated to 15° for baseline measurements ） |
| Cardiac Output measurement afterTrendelenburg Maneuver | 1 minute after starting Trendelenburg Maneuver | Cardiac Output measured after Trendelenburg Maneuver |
| Cardiac Output measurement after Dobutamine stress test | 5 minutes after dobutamine stress test | Cardiac Output measured after dobutamine stress test |
Countries
China
Contacts
Primary ContactGuo-wei Tu, Doctor
Backup ContactJun-yi Hou, Doctor
Outcome results
None listed