• Journal of critical care · Aug 2024

    Capillary refill time assessment after fluid challenge in patients on venoarterial extracorporeal membrane oxygenation: A retrospective study.

    • Geoffroy Hariri, Xavier Luxey, Stefanie Wenger, Pauline Dureau, Sarah Hariri, Ahmed Charfeddine, Guillaume Lebreton, Nima Djavidi, Aymeric Lancelot, Baptiste Duceau, and Adrien Bouglé.
    • Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Paris F-75013, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.. Electronic address: geoffroy.hariri@aphp.fr.
    • J Crit Care. 2024 Aug 1; 82: 154770154770.

    BackgroundMonitoring fluid therapy is challenging in patients assisted with Veno-arterial ECMO. The aim of our study was to evaluate the usefulness of capillary refill time to assess the response to fluid challenge in patients assisted with VA-ECMO.MethodsRetrospective monocentric study in a cardiac surgery ICU. We assess fluid responsiveness after a fluid challenge in patients on VA-ECMO. We recorded capillary refill time before and after fluid challenge and the evolution of global hemodynamic parameters.ResultsA total of 27 patients were included. The main indications for VA-ECMO were post-cardiotomy cardiogenic shock (44%). Thirteen patients (42%) were responders and 14 non-responders (58%). In the responder group, the index CRT decreased significantly (1.7 [1.5; 2.1] vs. 1.2 [1; 1.3] s; p = 0.01), whereas it remained stable in the non-responder group (1.4 [1.1; 2.5] vs. 1.6 [0.9; 1.9] s; p = 0.22). Diagnosis performance of CRT variation to assess response after fluid challenge shows an AUC of 0.68 (p = 0.10) with a sensitivity of 79% [95% CI, 52-92] and a specificity of 69% [95% CI, 42-87], with a threshold at 23%.ConclusionIn patients treated with VA-ECMO index capillary refill time is a reliable tool to assesses fluid responsiveness.SpecialtyCritical care, Cardiac surgery, ECMO.Copyright © 2023. Published by Elsevier Inc.

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