• Juliette Chommeloux, Santiago Montero, Guillaume Franchineau, Guillaume Lebreton, Nicolas Bréchot, Petra Barhoum, Lucie Lefèvre, Marc Pineton de Chambrun, Guillaume Hékimian, Charles-Edouard Luyt, Alain Combes, and Matthieu Schmidt.
• Sorbonne Université, UPMC Univ Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Cedex 13, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651 Paris Cedex 13, France.
• J Crit Care. 2022 Oct 1; 71: 154090154090.

PurposeVenoarterial extracorporeal membrane oxygenation (VA ECMO) effectively supports refractory cardiogenic shock (rCS), and sustains macro- and microcirculations. We investigated the respective impact of increasing VA ECMO flow or dobutamine dose on microcirculation in stabilized VA ECMO-treated patients with rCS.MethodsIn this prospective interventional study, we included consecutive intubated patients, with ECMO-supported rCS and hemodynamic stability, able to tolerate stepwise incremental dobutamine doses (from 5 to 20 gamma/kg/min) or ECMO flows (progressive increase by 25% above baseline ECMO flow. Baseline was defined as the lowest VA ECMO flow and dobutamine 5 μg/kg/min (DOBU5) to maintain mean arterial pressure (MAP) ≥ 65 mmHg. Macro- and microcirculations were evaluated after 30 min at each level.ResultsFourteen patients were included. Macro- and microcirculations were assessed 2 [2-5] days post-ECMO onset. Dobutamine-dose increments did not modify any microcirculation parameters. Only the De Backer score tended to be reduced (p = 0.08) by ECMO-flow increments whereas other microcirculation parameters were not affected. These findings did not differ between patients successfully weaned-off ECMO (n = 6) or not.ConclusionsWhen macrocirculation has already been restored in patients with ECMO-supported rCS, increasing dobutamine (above 5 μg/kg/min) or ECMO flow did not further improve microcirculation.Copyright © 2022 Elsevier Inc. All rights reserved.

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