A Retrospective Analysis Of The Value Of Left Ventricular Function Parameters By Bedside Ultrasound And Clinical Indicators In Weaning VA ECMO

Objective: clinical indicators and bedside echocardiographic left ventricular function parameters were used to dynamically monitor therapeutic effect of perioperative patients receiving VA ECMO support and to explore the guide value of left ventricular function parameters combined with related clinical indicators on the patients in weaning VA ECMO.Methods: Eighteen patients with VA ECMO assisted support in our hospital from June 2018 to August 2019 were selected.The bedside ultrasound was performed on the first day of ECMO support,the day before weaning,and immediately after weaning,and the clinical indicators at the corresponding time points were obtained.Compare parameter changes at different time points in different prognosis groups to find the relevant clinically parameters and ultrasound parameters that guid ing weaning.Results: Twelve patients were successfully weaned and six patients were fail weaned.Compared with the weaning failure group,patients in the weaning success group had higher mean arterial pressure on the day before weaning and on the day weaning,with statistically significant difference(P <0.05).In the weaning success group,inotropic drug dose score,serum creatinine and blood lactate were lower on the day before weaning and on the day weaning,with statistically significant difference(P <0.05).Furthermore,In the weaning success group,arterial oxygen saturation was higher at the three time points we detected,with statistically significant difference(P <0.05).In the weaning success group,TDI lat s',velocity-time integral(VTI),left venricular ejection fraction(LVEF),AV-Vmax,left ventricular global longitudinal strain(LVGLS),left ventricular global longitudinal strain rate(LVGLSr)all increased on the day before ECMO weaning compared with the first day of support,with statistically significant difference(all P < 0.05),while ECMO flow decreased,with statistically significant difference(P < 0.05).Compared with the day before weaning,Weaning instant TDI lat s',VTI,LVEF,LVGLS were further increased,with statistically significant difference(all P < 0.05).Among the parameters,there was no statistically significant difference between the first day of support and the day before weaning in the weaning failure group(all P > 0.05).With the auxiliary support of ECMO,there was a significant increase in ?LVEF,?TDI lat s',?AV-Vmax,?VTI,?LVGLS and ?LVGLSr in the weaning success group the day before weaning compared with the weaning failure group,the differences were statistica lly significant(all P < 0.05),while ?ECMO flow was reduce,with statistically significant difference(P < 0.05).Single factor correlation analysis using data from the day before weaning showed clinical parameters including mean arterial pressure(r=0.755,P <0.001),drug dose score(r=-0.645,P <0.001),serum creatinine(r=-0.509,P =0.006),blood lactate(r=-0.525,P =0.003),arterial oxygen saturation(r= 0.889,P <0.001)has strong correlation with ECMO successful weaning.Left ventricular function parameters including LVEF(r=0.625,P =0.005)?TDI lat s'(r=0.714,P <0.001)? VTI(r=0.689,P =0.002)?LVGLS(r=-0.728,P <0.001)?AV-Vmax(r=0.563,P =0.019)?LVGLSr(r=-0.523,P =0.031)and ECMO flow(r=-0.721,P <0.001)also has strong correlation with successful weaning.Draw the ROC curve for predicting successful weaning with parameters of left ventricular systolic function on the day before weaning,LVGLS,VTI,LVEF,TDI lat s',AV-Vmax all had high diagnostic efficiency,LVGLS diagnostic cut-off value was-6.75%(sensitivity 88.9%,specificity 100%),VTI diagnostic cut-off value was 9.4cm/s(sensitivity 100%,specificity 83.3%),LVEF diagnostic cut-off value was 34.5%(sensitivity 88.9%,specificity 83.3%),TDI lat s ' diagnostic cut-off value was 5.5cm(sensitivity 88.9%,sensitivity 83.3%),and the diagnostic cut-off value of AV-Vmax was 85cm/s(sensitivity 77.8%,specificity 83.3%).Conclusion: Bedside echocardiographic left ventricular function parameters(LVGLS,VTI,LVEF,TDI lat s',AV-Vmax)combined with clinical indicators(mean arterial pressure,inotropic drug dose score,serum creatinine,blood lactate and arterial oxygen saturation)is helpful to evaluate the therapeutic effect of patients receiving VA ECMO support and can provide important guid ing value in the selection of VA ECMO weaning timing and the judgment of prognosis.