Application Value Of Echocardiography In Cardiac Support In Patients With VA-ECMO

Objective:To evaluate the value of echocardiographic in the treatment of venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods:1.Case collection and grouping: Collect the Ultrasound data and clinical related data of 25 patients who underwent VA-ECMO support treatment in our hospital from June 2018 to February 2020.Weaning was successful in 16 cases and failed in 9 cases.Patients underwent routine transthoracic echocardiography before VA-ECMO was established within12 hours before weaning,and after weaning.The left atrial diameter,left ventricular diameter,right atrial diameter,right ventricular diameter,left ventricular ejection fraction,and aortic velocity time integral were routinely measured and recorded.Record the complications of the application of ECMO.At the same time,heart rate,systolic blood pressure,diastolic blood pressure,intra-aortic balloon counterpulsation were recorded,and the following biochemical indexes were collected:creatine kinase,L-lactate dehydrogenase,and troponin I.2.Statistical analysis: Pairwise comparison of measurement parameters is conducted by paired t-test or independent t-test,Fisher exact test was used to compare the counting data,and Pearson correlation analysis was used to analyze the correlation.Results:1.There was no significant difference in gender,the number of IABP cases,the constituent ratio of primary diseases and the assistant time of ECMO between the patients with successful weaning and those with failed weaning,there was significant difference in age between patients with successful weaning and patients with failed weaning(P<0.05).2.The levels of LVEF and VTIAV in successful weaning before and after weaning were significantly higher than those before establishment(P< 0.05).The levels of LVEF and VTIAV in failed weaning before and after weaning were significantly higher than those before establishment(P< 0.05).In the pairwise comparison of LVEF and VTIAV between the successful weaning and the failed weaning,there was no significant difference between the two groups before establishment,but there were significant differences before and after weaning(P<0.05).3.There was no significant difference in inner diameter changes of LA,LV,RA and RV between patients with successful weaning and patients with failed weaning during this study.4.The main complications detected by ultrasound in this study were pericardial effusion in 10 cases(40%),thrombus in 3 cases(12%),hematoma in 3 cases(12%)and lower limb ischemia in 1 case(4%).5.The changes of CK,LDH and CTn I in patients with successful weaning before establishment were significantly different from those before and after weaning(P<0.05).In patients with failed weaning,there was no significant difference in CK and LDH before and after weaning,but there was significant difference in CTn I(P <0.05).In patients with failure of weaning,there was no significant difference in LDH before and after weaning,and there was significant difference in CK and CTn I(P<0.05).In the comparison of CK,LDH and CTn I between patients with successful weaning and patients with failed weaning,there was significant difference in CK and LDH before establishment(P < 0.05),but there was no significant difference in CTn I before establishment.There were significant differences in CK,LDH and CTn I before and after weaning(P<0.05).6.There was no significant difference in HR between the two groups during the whole study period.SBP and DBP in the successful weaning before and after weaning were significantly higher than before establishment,and the differences were statistically significant(P <0.05).There was no significant difference in SBP and DBP before and after weaned in the failed weaning compared with before weaned.In the pairwise comparison of SBP and DBP between the successful weaning and the failed weaning,there was no significant difference in the two indexes before establishment,but there were significant differences before and after withdrawal(P<0.05).7.Correlation analysis between LVEF and VTIAV,SBP and DBP,LDH,CK and CTn I in survival group,results show that LVEF is positively correlated with VTIAV,SBP and DBP(r=0.900,P < 0.001;r=0.675,P < 0.001;r=0.454,P < 0.001),and LVEF was negatively correlated with LDH,CK and CTn I(r=-0.513,P < 0.001;r=-0.366,P=0.001;r=-0.736,P<0.001).Conclusion:1.Echocardiography has important application value in VA-ECMO supportive therapy.It is an important tool for monitoring cardiac function,choosing the time of weaning and judging the prognosis of patients.2.LVEF and VTIAV can be used as indicators to evaluate the therapeutic effect of VA-ECMO.The increase of LVEF and VTIAV indicates that the treatment is effective,while the decrease of LVEF and VTIAV indicates that the therapeutic effect is not good,LVEF > 40% 、VTIAV > 10 cmcan be used as indicators to indicate the timing of withdrawal.3.Echocardiography can detect complications related to VA-ECMO support in time.4.LVEF was negatively correlated with myocardial injury markers LDH,CK,and CTn I,and positively correlated with VTIAV,SBP,and DBP.5.LVEF combined with myocardial injury markers LDH,CK and CTn I and hemodynamic indexes SBP and DBP can more accurately evaluate the therapeutic effect of patients with VA-ECMO support.