A Clinical Study Of Pump Controlled Retrograde Trial Off For VA-ECMO Assisted Weaning In Cardiogenic Shock

Objective:To compare the clinical efficacy of traditional weaning(continuous reduction of assisted blood flow)and Pump controlled retrograde trial off(PCRTO)in cardiogenic shock(VA-ECMO)assisted weaning,evaluate the clinical value of PCRTO in cardiogenic shock VA-ECMO assisted weaning,and determine the efficacy and safety of PCRTO in predicting VA-ECMOC weaning in patients with cardiogenic shock.Objective:To compare the clinical efficacy of traditional weaning(continuous reduction of assisted blood flow)and pump-controlled retrograde flow trial off(PCRTO)in veno-arterial extracorporeal membrane oxygenation(VA-ECMO)assisted weaning in cardiogenic shock,evaluate the clinical value of PCRTO in VA-ECMO assisted weaning in cardiogenic shock,and determine the efficacy and safety of PCRTO in predicting VA-ECMO weaning in patients with cardiogenic shock.METHODS:From March 2021 to October 2022,patients with cardiogenic shock were treated with VA-ECMO in the Department of Intensive Care,Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College.They were divided into test group(PCRTO)and control group(traditional weaning test)according to the random table,with 20 cases in each group.The general conditions of patients before adjuvant therapy with VA-ECMO were recorded,and the partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),central venous oxygen saturation(ScVO2),perfusion(Lac)and vascular inotropic score(VIS)before and after the test were compared between the test group and the control group;cardiac ultrasound parameters:left ventricular ejection fraction(LVEF),aortic blood flow velocity score(VTI),left ventricular end diastolic diameter(LVEDD),tricuspid valve systolic displacement(TAPSE),partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),central venous oxygen saturation(ScVO2),lactate(Lac),creatine kinase isoenzyme(CK-MB),brain natriuretic peptide(BNP),creatinine(Cr),total bilirubin(TBil),international normalized ratio(INR),D-dimer and other data were recorded and compared;The success rate of weaning,the incidence of complications,the duration of ECMO use,and the 28-day survival rate were followed up in the two groups under different weaning methods.Results:During the period from March 2021 to October 2022,VA-ECMO was used as an adjunctive therapy for patients with cardiogenic shock in the Intensive Care Department of Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College.A total of 40 patients with cardiogenic shock were randomly divided into test group(PCRTO test group)and control group(traditional weaning test)according to random table.There was no significant difference in the general conditions of patients before VA-ECMO adjuvant therapy between the test group and the control group(p>0.05).PCRTO group had significant differences in functional withdrawal rate(80%vs 50%,p=0.047)and ECMO use time(97.03 ± 20.87 vs 116.69±32.12,p=0.027),and the differences were statistically significant(p<0.05);there was no significant difference in ICU length of stay,28-day survival rate,and complications(bleeding,thrombosis)between the two groups(p>0.05).When compared within groups,PCRTO showed an increasing trend with traditional weaning ejection fraction,VTI,LVEDD,and TAPSE three days after weaning,and there were significant differences on the third day after weaning(p<0.05);CK-MB,BNP,CRP,and INR decreased on the third day after weaning,and the differences were statistically significant(p<0.05);PaO2,PaCO2,ScVO2,Lac,Cr,TBil,and D-dimer were not significantly different(p>0.05).Compared between groups,there was a significant difference in Lac(1.16 ± 0.21 vs 1.56 ± 0.41,p<0.05)on the second day after weaning;there were significant differences in BNP(368.57 ± 178.81 vs 607.57 ± 227.96,p<0.05)and TAPSE(14.45 ± 1.24 vs 13.69 ±1.03,p<0.05)on the third day after weaning.Conclusion:PCRTO can maintain the integrity of circulatory circuit during VA-ECMO weaning,evaluate cardiopulmonary reserve during ECMO test,reduce the use time of ECMO and improve the success rate of ECMO weaning.It is a simple,reversible,effective and safe weaning method.