Venoarterial extracorporeal membrane oxygenation flow or dobutamine to improve microcirculation during ECMO for refractory cardiogenic shock

J Crit Care. 2022 Oct;71:154090. doi: 10.1016/j.jcrc.2022.154090. Epub 2022 Jun 11.

Abstract

Purpose: Venoarterial extracorporeal membrane oxygenation (VA ECMO) effectively supports refractory cardiogenic shock (rCS), and sustains macro- and microcirculations. We investigated the respective impact of increasing VA ECMO flow or dobutamine dose on microcirculation in stabilized VA ECMO-treated patients with rCS.

Methods: In this prospective interventional study, we included consecutive intubated patients, with ECMO-supported rCS and hemodynamic stability, able to tolerate stepwise incremental dobutamine doses (from 5 to 20 gamma/kg/min) or ECMO flows (progressive increase by 25% above baseline ECMO flow. Baseline was defined as the lowest VA ECMO flow and dobutamine 5 μg/kg/min (DOBU5) to maintain mean arterial pressure (MAP) ≥ 65 mmHg. Macro- and microcirculations were evaluated after 30 min at each level.

Results: Fourteen patients were included. Macro- and microcirculations were assessed 2 [2-5] days post-ECMO onset. Dobutamine-dose increments did not modify any microcirculation parameters. Only the De Backer score tended to be reduced (p = 0.08) by ECMO-flow increments whereas other microcirculation parameters were not affected. These findings did not differ between patients successfully weaned-off ECMO (n = 6) or not.

Conclusions: When macrocirculation has already been restored in patients with ECMO-supported rCS, increasing dobutamine (above 5 μg/kg/min) or ECMO flow did not further improve microcirculation.

Keywords: Cardiogenic shock; Extracorporeal membrane oxygenation; Microcirculation; Outcomes.

MeSH terms

  • Dobutamine / pharmacology
  • Dobutamine / therapeutic use
  • Extracorporeal Membrane Oxygenation*
  • Humans
  • Microcirculation
  • Prospective Studies
  • Retrospective Studies
  • Shock, Cardiogenic* / therapy

Substances

  • Dobutamine