Skin microvascular morphology and hemodynamics during treatment with veno-arterial extra-corporeal membrane oxygenation

Torjus Wester, Zaheer Ahmed Awan, Tobias Skylstad Kvernebo, Göran Salerud, Knut Kvernebo
2014 Clinical Hemorheology and Microcirculation  
OBJECTIVES: To explore the potentials of microcirculatory assessments for predicting outcome of patients treated with extra corporeal membrane oxygenation for cardiogenic shock. METHODS: Eight patients with acute cardiogenic shock treated with ECMO and eight healthy controls were examined with skin vital microscopy and laser Doppler perfusion measurements. RESULTS: Three patients died on ECMO (group 1). Five patients were successfully weaned off ECMO (group 2). Four patients were discharged
more » ... were discharged from hospital and one died after successful weaning from bleeding complications. Patients surviving ECMO (group 2) had microcirculatory findings comparable with healthy controls. Patients in group 1 showed major skin microvascular pathology: pericapillary bleedings (n = 1), pericapillary dark haloes (n = 2) and capillary micro thrombi (n = 1). As compared with survivors they had lower functional capillary density (FCD) (n = 3), higher heterogeneity of functional capillary density (n = 3) and significantly reduced capillary mean flow-categorical velocity (n = 2). Laser Doppler measurements in group 1 had non-significant lower laser Doppler flux values as compared with survivors and controls. CONCLUSION: Skin microvascular pathology as detected with video microscopy (pericapillary bleedings or haloes, microthrombi/capillaries with "no flow", low FCD with high spatial distribution heterogeneity or low mean flow-categorial velocity) seems to be associated with poor prognosis.
doi:10.3233/ch-131670 fatcat:hs4mfamgmbga3hyhjxutgfwt2a