Refractory cardiogenic shock is characterized by a decreased in cardiac output with hypo-responsiveness to increasing doses of catecholamines resulting in a profound tissular ischemia. VAECMO, by restoring a circulatory flow, could be associated to a major reperfusion syndrome which may lead some patients to multiple organ failures and death. Pathophysiology of this syndrome includes 1/an hyper-adrenergic state secondary to the over activation of the sympathetic system and 2/ a major release of pro-inflammatory cytokines. As adrenoreceptors are also exhibited on immunes cells, the pro-inflammatory state might be enhanced by the over-activation of the sympathetic system.
NB : A repartition according to other ongoing study (HYPOECMO NCTNCT02754193) is planned
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
48
We will assess in all patients under ECLS for the treatment of a cardiogenic shock at day 0 (ECLS initiation) day 3 and day "ECLS weaning" : Biological assessment: 1. Adrenoreceptors α1, α2, β1, β2, β3 on monocytes and lymphocytes T helper by flow cytometry 2. Lymphocytes Th1/Th2 pattern by flow cytometry 3. Cytokines on plasma : Interleukin (IL) 4, IL 12, TNF α, INF γ , IL1, IL6, IL10 Clinical assessment: 1. Hemodynamic parameters 2. Cumulated doses of catecholamines 3. Cardiac output variation measured by echocardiography during a standardized weaning procedure of ECLS at a constant mean arterial pressure (only on day 3 and Day "ECLS weaning")
CHRU Nancy
Nancy, France
Change in Cytokines (plasma TNF α, INF γ, IL4, IL 12, IL1 IL 6 IL 10)
Exposition variable will be the density of α1, α2, β1, β2, β3-adrenoreceptors on immune cells (monocytes and lymphocytes T helper)
Time frame: day 0 (ECLS initiation), day 3, day "ECLS weaning"
Change in hemodynamic parameters
Arterial pressures
Time frame: day 0 (ECLS initiation), day 3, day "ECLS weaning"
Change in hemodynamic parameters
heart rate
Time frame: day 0 (ECLS initiation), day 3, day "ECLS weaning"
Change in hemodynamic parameters
cumulated doses of catecholamines
Time frame: day 0 (ECLS initiation), day 3, day "ECLS weaning"
Cardiac output variation during a weaning ECLS procedure
At a constant mean arterial pressure (65-75 mmHg), measurement by echocardiography of cardiac output at 2 times: * baseline (3L/min of ECLS flow) * after 45 min at weaning output (1.5 L/min of ECLS flow) Variation of norepinephrine doses will be also recorded
Time frame: day 3, day "ECLS weaning"
Mortality
Time frame: 28 days and 90 days
Change in TH1 and TH2 pattern
Assessment in CD3/CD4 + cells of INF γ; IL12 (TH1) and IL4 (TH2)
Time frame: day 0 (ECLS initation), day 3, day "ECLS weaning"
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