Most frequently reported variables associated with higher likelihood of weaning from pVAD
| Variable . | Value . | Comment and experience in MCS . |
|---|---|---|
| Echocardiography | ||
| LVOT VTI | >10–12 cm | Is a measure of native heart stroke volume. Observational studies suggest that a value >10 cm is associated with increased likelihood of weaning success. Measure is based on PW Doppler, thus, angle dependent between flow direction and Doppler cursor, further load dependent at affected by aortic regurgitation. Only data in V-A ECMO supported patients.68,69 |
| LVEF | >25% or increase >5% within 48 h | Measure of total LV stroke volume relative to end-diastolic volume. Value >20–25% associated with higher likelihood of weaning success. Mitral regurgitation will overestimate forward flow, load dependent and heavily dependent on good image quality. Only data in V-A ECMO supported patients.68,69 |
| TDI S′lat | >6 cm/s | Tissue Doppler measurement of velocity of myocardial movement. Doppler cursor placed in lateral mitral annulus will provide information on LV systolic function and diastolic using e′. Angle dependent and cannot differentiate between active and passive movements. Only data in V-A ECMO supported patients.68–70 |
| Other | ||
| EtCO2 | Increase >5 mmHg | Measure of flow through the lungs thus intrinsic heart function in V-A ECMO supported patients. An increase >5 mmHg measured 12 h apart suggest likelihood of weaning. Subject to ventilator settings. Only data in V-A ECMO supported patients and in axial flow pump supported patients EtCO2 will be sum of device flow and intrinsic heart function.71 |
| Variable . | Value . | Comment and experience in MCS . |
|---|---|---|
| Echocardiography | ||
| LVOT VTI | >10–12 cm | Is a measure of native heart stroke volume. Observational studies suggest that a value >10 cm is associated with increased likelihood of weaning success. Measure is based on PW Doppler, thus, angle dependent between flow direction and Doppler cursor, further load dependent at affected by aortic regurgitation. Only data in V-A ECMO supported patients.68,69 |
| LVEF | >25% or increase >5% within 48 h | Measure of total LV stroke volume relative to end-diastolic volume. Value >20–25% associated with higher likelihood of weaning success. Mitral regurgitation will overestimate forward flow, load dependent and heavily dependent on good image quality. Only data in V-A ECMO supported patients.68,69 |
| TDI S′lat | >6 cm/s | Tissue Doppler measurement of velocity of myocardial movement. Doppler cursor placed in lateral mitral annulus will provide information on LV systolic function and diastolic using e′. Angle dependent and cannot differentiate between active and passive movements. Only data in V-A ECMO supported patients.68–70 |
| Other | ||
| EtCO2 | Increase >5 mmHg | Measure of flow through the lungs thus intrinsic heart function in V-A ECMO supported patients. An increase >5 mmHg measured 12 h apart suggest likelihood of weaning. Subject to ventilator settings. Only data in V-A ECMO supported patients and in axial flow pump supported patients EtCO2 will be sum of device flow and intrinsic heart function.71 |
EtCO2, end tidal CO2; LVOT, left ventricular outflow tract; LVEF, left ventricular ejection fraction; TDI, tissue Doppler imaging; VTI, velocity time integral.
Most frequently reported variables associated with higher likelihood of weaning from pVAD
| Variable . | Value . | Comment and experience in MCS . |
|---|---|---|
| Echocardiography | ||
| LVOT VTI | >10–12 cm | Is a measure of native heart stroke volume. Observational studies suggest that a value >10 cm is associated with increased likelihood of weaning success. Measure is based on PW Doppler, thus, angle dependent between flow direction and Doppler cursor, further load dependent at affected by aortic regurgitation. Only data in V-A ECMO supported patients.68,69 |
| LVEF | >25% or increase >5% within 48 h | Measure of total LV stroke volume relative to end-diastolic volume. Value >20–25% associated with higher likelihood of weaning success. Mitral regurgitation will overestimate forward flow, load dependent and heavily dependent on good image quality. Only data in V-A ECMO supported patients.68,69 |
| TDI S′lat | >6 cm/s | Tissue Doppler measurement of velocity of myocardial movement. Doppler cursor placed in lateral mitral annulus will provide information on LV systolic function and diastolic using e′. Angle dependent and cannot differentiate between active and passive movements. Only data in V-A ECMO supported patients.68–70 |
| Other | ||
| EtCO2 | Increase >5 mmHg | Measure of flow through the lungs thus intrinsic heart function in V-A ECMO supported patients. An increase >5 mmHg measured 12 h apart suggest likelihood of weaning. Subject to ventilator settings. Only data in V-A ECMO supported patients and in axial flow pump supported patients EtCO2 will be sum of device flow and intrinsic heart function.71 |
| Variable . | Value . | Comment and experience in MCS . |
|---|---|---|
| Echocardiography | ||
| LVOT VTI | >10–12 cm | Is a measure of native heart stroke volume. Observational studies suggest that a value >10 cm is associated with increased likelihood of weaning success. Measure is based on PW Doppler, thus, angle dependent between flow direction and Doppler cursor, further load dependent at affected by aortic regurgitation. Only data in V-A ECMO supported patients.68,69 |
| LVEF | >25% or increase >5% within 48 h | Measure of total LV stroke volume relative to end-diastolic volume. Value >20–25% associated with higher likelihood of weaning success. Mitral regurgitation will overestimate forward flow, load dependent and heavily dependent on good image quality. Only data in V-A ECMO supported patients.68,69 |
| TDI S′lat | >6 cm/s | Tissue Doppler measurement of velocity of myocardial movement. Doppler cursor placed in lateral mitral annulus will provide information on LV systolic function and diastolic using e′. Angle dependent and cannot differentiate between active and passive movements. Only data in V-A ECMO supported patients.68–70 |
| Other | ||
| EtCO2 | Increase >5 mmHg | Measure of flow through the lungs thus intrinsic heart function in V-A ECMO supported patients. An increase >5 mmHg measured 12 h apart suggest likelihood of weaning. Subject to ventilator settings. Only data in V-A ECMO supported patients and in axial flow pump supported patients EtCO2 will be sum of device flow and intrinsic heart function.71 |
EtCO2, end tidal CO2; LVOT, left ventricular outflow tract; LVEF, left ventricular ejection fraction; TDI, tissue Doppler imaging; VTI, velocity time integral.
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