Integrating pulmonary artery pulsatility index and coupling ratios guides VA-ECMO management in right ventricular infarction, with successful weaning achieved when PAPI exceeds 1.5.
Does an integrated echo-hemodynamic framework using PAPI and RV-PA coupling ratios help guide VA-ECMO decision-making in patients with RV myocardial infarction and cardiogenic shock?
Integrating PAPI and RV-PA coupling ratios provides complementary information on hemodynamic reserve and intrinsic RV function to guide VA-ECMO initiation and weaning in RV infarction.
Tasa de eventos absoluta: 0% vs 0%
Right ventricular (RV) myocardial infarction with cardiogenic shock presents complex management challenges. We present 3 cases illustrating a potential integrated approach combining pulmonary artery pulsatility index (PAPI) and RV-pulmonary artery coupling ratios (tricuspid annular systolic velocity/pulmonary artery systolic pressure, tricuspid annular plane systolic excursion/pulmonary artery systolic pressure) for venoarterial extracorporeal membrane oxygenation decision-making. Case 1 (PAPI = 0.47) and case 2 (PAPI = 0.64) required venoarterial extracorporeal membrane oxygenation with successful weaning when PAPI exceeded 1.5. Case 3 (PAPI = 1.05) was managed conservatively. In case 2, inhaled nitric oxide (iNO) improved PAPI during weaning. In case 3, iNO caused paradoxical deterioration necessitating discontinuation. Based on these observations, we suggest that PAPI and coupling ratios provide complementary information: PAPI reflects hemodynamic reserve, whereas coupling ratios assess intrinsic RV function. Neither parameter alone is sufficient; integration of both guides clinical decisions. Prospective validation is needed. For iNO use without mechanical support, adequate left ventricular reserve is critical; PAPI decline mandates immediate discontinuation.
Horiguchi et al. (Sun,) reported a other. Integrating pulmonary artery pulsatility index and coupling ratios guides VA-ECMO management in right ventricular infarction, with successful weaning achieved when PAPI exceeds 1.5.