Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale

Antoine P Simons, Marcus D Lancé, Koen D Reesink, Frederik H van der Veen, Patrick W Weerwind, Jos G Maessen, Antoine P Simons, Marcus D Lancé, Koen D Reesink, Frederik H van der Veen, Patrick W Weerwind, Jos G Maessen

Abstract

We describe a case of a patient assisted by extracorporeal life support, in which we obtained the dynamic filling index, a measure for venous volume during extracorporeal life support, and used this index to assess cardiac load-responsiveness during acute reloading. While reloading, the obtained findings on cardiac pump function by the dynamic filling index were supported by trans-esophageal echocardiography and standard pressure measurement. This suggests that the dynamic filling index can be used to assess cardiac load-responsiveness during extracorporeal life support.

Figures

Figure 1
Figure 1
Rationale behind the use of venous volume measurement (dynamic filling index, DFI) in testing cardiac load-responsiveness. With acute reduction of pump flow (e.g. from 4 to 2 l/min), the patient remains hemodynamically stable if cardiac load-responsiveness is sufficient (upper left). If cardiac load-responsiveness is blunted, the heart is not able to take over output, and venous volume will increase (upper right). Venous volume modulates the relation between pump speed (s) and flow (f) in the assisted circulation, which can be quantified by the DFI, i.e. the slope of the curve Δf/Δs. The DFI will not increase with diminished ELS flow when cardiac load-responsiveness is good (lower left), but will increase if cardiac load-responsiveness is decreased (lower right). CVP, central venous pressure; ABP, arterial blood pressure; RV, right ventricle; LV, left ventricle; SVR, systemic vascular resistance.
Figure 2
Figure 2
Hemodynamic parameters during cardiac reloading of the patient supported by extracorporeal life support. During the first event (left), DFI increased notably with diminished ELS flow. With the second event (right), DFI increased only marginally, suggesting increased cardiac load-responsiveness. MAP, mean arterial pressure; CVP, central venous pressure DFI, dynamic filling index.

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