A research team at Samsung Medical Center (SMC) said Thursday that it has discovered a predictor of successful removal of extracorporeal membrane oxygenation (ECMO) inserted to treat patients with cardiogenic shock.

Samsung Medical Center Heart, Vascular, and Stroke Institute Professors Kim Da-rae (left) and Yang Jeong-hoon have found a predictor for successful removal of extracorporeal membrane oxygenation (ECMO) inserted to treat patients with cardiogenic shock. (SMC)
Samsung Medical Center Heart, Vascular, and Stroke Institute Professors Kim Da-rae (left) and Yang Jeong-hoon have found a predictor for successful removal of extracorporeal membrane oxygenation (ECMO) inserted to treat patients with cardiogenic shock. (SMC)

The research team, led by Heart, Vascular and Stroke Institute Professors Kim Da-rae and Yang Jeong-hoon, said study results are significant as they suggest that successful removal can be predicted using echocardiography in a stable condition without lowering the flow rate of ECMO.

Most of the existing studies have focused on left ventricular (LV) systolic function while maintaining minimum flow with a gradual decrease in ECMO flow. However, the current removal method had limitations as the patient's blood pressure could suddenly drop during an attempt to reduce the flow rate, or blood clots could form due to repeated blood flow changes.

Arteriovenous ECMO is an extracorporeal membrane oxygenation device that draws deoxygenated blood out of the patient's body through a pump in emergencies, including cardiac arrest. It supplies oxygenated blood to patients through the artery, mainly used for refractory cardiogenic shock.

Echocardiography plays a key role in determining readiness for ECMO removal.

The probability of device-related complications may increase when patients maintain ECMO treatment for too long, making it important to consider removing the device early when the heart’s function fully recovers.

Researchers devised the study by tracking and analyzing 79 patients admitted to the intensive care unit due to cardiogenic shock and received ECMO therapy between 2016 and 2019. The team evaluated the function and interaction of the right ventricle (RV) and the pulmonary circulation (PC) by measuring the RV-PC coupling index while performing echocardiography at a central ECMO flow rate of 3.2 liters per minute an average of one to six days.

The researchers had been trying to predict successful removal of ECMO using three indexes of RV-PC coupling, and the study showed satisfying results considering a simple design without risk of decreased flow rate, SMC said in a press release.

"Our study result will significantly help determine the treatment direction for patients with cardiogenic shock and severe heart failure as evaluating RV-PC coupling index can predict successful removal of ECMO without lowered flow rate," Professor Kim said.

SMC implemented ECMO in 2003 for the first time in Korea, and other large Korean hospitals began using it widely by the late 2000s. In 2014, the medical center launched a team consisting of professors from critical care medicine, cardiology, and cardiac surgery departments, which has taken the lead in treating critically ill patients with enhanced systems and health providers.

The study results were published in the latest issue of the U.S. Journal of the American College of Cardiology Cardiovascular Imaging.

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