The Consistency of Cardiac Output Measurements by Different Methods in VA-ECMO Patients
Study Details
Study Description
Brief Summary
Objective：
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To evaluate the consistency of cardiac output measured by different hemodynamic monitoring methods in patients with VA-ECMO
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To evaluate whether different hemodynamic monitoring methods can accurately detect the trend of cardiac output changes
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Trendelenburg Maneuver The Trendelenburg position is a common treatment in medicine.It is used either as a diagnostic tool to assess fluid loading response or as a therapeutic maneuver pending fluid resuscitation.With the advantage of autotransfusion readily available,the Trendelenburg position is used for expected instantaneous effect on cardiovascular performance. |
Diagnostic Test: Trendelenburg 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.
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| Experimental: dobutamine stress test Dobutamine is a selective beta 1 receptor agonist. It [<10 ug/(kg.min)] can effectively increase myocardial contractility. |
Diagnostic Test: dobutamine 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.
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Outcome Measures
Primary Outcome Measures
- 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
Eligibility Criteria
Criteria
Inclusion Criteria:
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cardiac surgery
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treatment with VA-ECMO
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mechanical ventilation
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hemodynamic monitoring according to patient's condition (PAC, Flotrac, echocardiography)
Exclusion Criteria:
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age < 18
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cardiac arrhythmia
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moderate to severe aortic, mitral and tricuspid regurgitation
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active hemorrhage
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IABP
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spontaneous triggering of the ventilator
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Zhongshan hospital, Fudan university | Shanghai | China | 200032 |
Sponsors and Collaborators
- Shanghai Zhongshan Hospital
Investigators
- Study Chair: Zhe Luo, Doctor, Fudan University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- COMMENT