Work

Control of Cardiac Output with Ivabradine or Beta-Blockers for Refractory Hypoxemia under Veno-Venous ECMO for Severe ARDS

Year: 2024

Type: article

Abstract: Purpose Hypoxemia is a risk factor for mortality and long-term neuropsychological impairment during severe acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a potential treatment for such cases but may not suffice. We aimed to evaluate the effects of pharmacological interventions for cardiac output (CO) control using ivabradine or beta-blockers for refractory hypoxemia during VV-ECMO. Methods The study involved retrospective analysis of consecutive patients with severe ARDS who underwent VV-ECMO at a tertiary university hospital between March 2020 and May 2022. Patients with refractory hypoxemia under VV-ECMO were included. Pharmacological interventions included ivabradine and/or short half-life beta-blockers. The primary endpoint was the change in ECMO flow/CO ratio and secondary endpoints were changes in macrocirculation (mean arterial pressure), oxygenation [arterial saturation (SaO 2 ) and oxygen transport (DO 2 )] and tissue hypoxia (lactate levels). Results Out of 70 patients on VV-ECMO, ten had refractory hypoxemia under VV-ECMO and received pharmacological interventions to control CO. The ECMO flow/CO ratio significantly increased with pharmacological intervention overall (from 60% [50–66] to 69% [61–81], p = 0.02), as well as with beta-blockers or ivabradine individually. However, DO 2 decreased, especially with beta-blockers and to some extent with ivabradine. There were no reported immediate adverse events, and lactate levels remained below the anaerobic threshold. Conclusion Ivabradine and beta-blockers were clinically well-tolerated and improved the ECMO flow/CO ratio in patients with refractory hypoxemia during VV-ECMO. However, the improvement of arterial oxygenation was associated with decreased DO 2 .

Source: Cardiovascular Drugs and Therapy

DOI: 10.1007/s10557-024-07650-5

Authors: Paul Masi, Lionel Tchatat Wangueu, François Bagate, Alexandra Plesa, Thierry Folliguet, Armand Mekontso Dessap

Institutions: Université Paris-Est Créteil, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor

Language: English

Topic: Mechanical Circulatory Support Devices

Subfield: Biomedical Engineering

Field: Engineering

Domain: Physical Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,190