University of Twente Student Theses


Potential of Pulse Pressure as an indicator for contractility of the heart and successful weaning from Extracorporeal Membrane Oxygenation

Kraan, C.L.M. and Wechem, M.M. van and Mes, E.E. (2023) Potential of Pulse Pressure as an indicator for contractility of the heart and successful weaning from Extracorporeal Membrane Oxygenation.

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Abstract:Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to offer mechanical circulatory support to patients in cardiogenic shock (CS). However, determining whether patients can successfully wean from VA-ECMO is challenging, due to the complex hemodynamic interaction between the patient and VA-ECMO. Pulse pressure (PP) holds the potential to be a predictor of intrinsic cardiac contractility and could provide guidance in clinical decision-making. The aim of this study is to analyze PP over time and the effects of other hemodynamic factors and VA-ECMO settings to investigate whether the PP can serve as a potential indicator for determining the successful weaning form VA-ECMO. Method: Data of 88 patients was used by dividing them into subsets based on heart or lung indication and weaning outcome. The absolute pulse pressure (PP) as well as the relative PP are plotted against time to visualize the trends. Relations between PP and heart rate (HR), age and BMI are explored using scatterplots. Subsequently, the effect of these factors on the PP is filtered to evaluate changes in the trends. The same is done for VA-ECMO revolutions per minute (RPM). The increase per 24 hours is calculated to determine when the increase of the PP is at its maximum. To get insight into the significance of the results, the Pearson's Chi-squared test Mann-Whitney U and the Pearson Correlation test are performed. Results: Based on this report the following results were obtained. The mean relative PP differs between recovered and non-recovered patients. The median of the total change is significantly different for each outcome (p = 0,031). The maximum increase of PP took place on day one for most patients and the mean change in PP per day decreases over time. It was also discovered that for unrecovered patients an increase in heart rate, means a decrease in PP. A significant relation was also found between age and PP (r=0,21and p = 0,05), older patients have a higher pulse pressure. When evaluating the influence of change in ECMO RPM on PP no trend could be observed for both outcomes. Conclusion: Based on the results it was concluded that successfully weaned patients do on average show a higher relative PP compared to patients who do not wean successfully. When evaluating the PP as an potential indicator for recovery of the heart and therefore successful weaning, a doctor should take the heart rate into consideration. This also applies to the age, since a weak linear relation was found. The BMI and the influence of change of ECMO RPM on PP should not be considered, because no relation has been observed. The chance of showing a maximum increase in PP is highest on day one on VA-EMCO. After day one the chance of showing maximum increase lowers as days on VA-ECMO progress.
Item Type:Essay (Bachelor)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine BSc (50033)
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