Evolution of Diaphragm Thickness Under Veno-arterial ECMO

Study Overview
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Brief Summary
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The main objective is to evaluate the evolution of the thickness of the diaphragm (during the first week of treatment) by VA ECMO in the resuscitation patients. The comprehension of the mechanisms involved in the diaphragm ailment will identify modifiable factors that lead to muscle degradation and thus to the deterioration of patients' prognosis.

Detailed Description
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The evolution of diaphragm muscle thickness is described in human resuscitation under mechanical ventilation, but the incidence, causes and functional impact have not been studied in patients undergoing cardiopulmonary bypass ECMO (extra-corporeal membrane oxygenation) veno-arterial (VA). More generally, the muscular mechanisms of dyspnea in cases of acute cardiac dysfunction are not known. The evolution of the diaphragmatic thickness in intensive care has been described during prolonged stay in intensive care and from the initial phase of septic status. It is associated with dyspnea, weaning delay of mechanical ventilation and impact on patient outcomes. The atrophy of the diaphragm muscle is related to both loss of function and loss of muscle performance. The same is true for hypertrophy that is caused by overuse of the muscle and also causes loss of function. Decreased cardiac muscle performance may require both cardiac assistance and respiratory assistance. Cardiac and respiratory dysfunction may complicate withdrawal of respiratory assistance and extracorporeal circulatory support devices. These two supports, respiratory and circulatory support, make it possible to mitigate the insufficiency of the systemic flow, the oxygenation and the purification of the CO2. Respiratory assistance is known to influence the diaphragmatic function. The role of muscle pump function in the weaning process of the ECMO, however, remains largely unknown. Ultrasound is used in the patient's bed in daily practice to measure cardiac function, the study of vessels but also the diaphragm muscle. It allows to study the trophicity of the diaphragm and these efforts via its contraction. The hypothesis that there is muscular involvement of the diaphragm in this measurable condition by ultrasound method can be formulated. No study has systematically explored the existence of diaphragmatic atrophy under VA ECMO. The influence of cardiac and respiratory assistance is not known. The purpose of this study is to provide a description of the diaphragm physiology of patients treated with VA ECMO. It is to evaluate the evolution of the trophicity of the diaphragm muscle in intensive care. Secondly, to evaluate the factors that influence it at the time of weaning. In this study it's planed to include a cohort of patients with a longitudinal evaluation of the thickness of the diaphragm during a cardiogenic shock under ECMO, and an evaluation of the influence of ECMO parameters and ventilation on the diaphragm.

Official Title
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Evolution of Diaphragm Thickness Under Veno-arterial ECMO : Observational Study

Conditions
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Diaphragm, Extracorporeal Membrane Oxygenation Complication

Intervention / Treatment
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* Other: ultrasound measure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient hospitalized in intensive care Patient under veno-arterial ECMO Non-opposition of the patient or relatives Affiliation to a health insurance Exclusion Criteria: Subject under guardianship or subject deprived of liberty Pregnant or lactating woman

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: ultrasound measure|Admission to the intensive care unit, and setting up an ECMO Daily monitoring from D1 to D7, follow up at D60|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate the evolution of the trophicity of the diaphragm muscle during the first week of treatment with VA ECMO in patients in intensive care. | Evaluation of the trophicity of the diaphragm muscle at the end of the expiration from the first day in the intensive care unit after the ECMO implementation until the D7 of the hospitalization with ultrasound. A change greater than 10% of the thickness will define three groups of patients (loss of thickness, stability and thickness gain). The first day that this value is reached will determine the allocation in one or the other group. | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate the evolution of the performance of the diaphragm muscle in patients in intensive care. | Measurement of the thickening fraction of the diaphragm. | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the evolution of respiratory physiological variables and the diaphragm evolution in patients in intensive care. | Measurement of the daily evolution of tidal volume during ultrasound collection | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the evolution of respiratory physiological variables and the diaphragm evolution in patients in intensive care. | Measurement of the daily evolution of respiratory rate during ultrasound collection | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the evolution of respiratory physiological variables and the diaphragm evolution in patients in intensive care. | Measurement of the daily evolution of pulse oximetry during ultrasound collection | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the evolution of respiratory physiological variables and the diaphragm evolution in patients in intensive care. | Measurement of the daily evolution of occlusion pressure at 100ms (P0.1)during ultrasound collection | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the evolution of respiratory physiological variables and the diaphragm evolution in patients in intensive care. | Measurement of the daily evolution of maximum inspiratory pressure (MIP) during ultrasound collection | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the evolution of respiratory physiological variables and the diaphragm evolution in patients in intensive care. | Measurement of the daily evolution of SNIFF test during ultrasound collection | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily ventilatory mode | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily tidal volume | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily respiratory rate | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily positive expiratory pressure | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily plateau pressure | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily motor pressure | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily transpulmonary pressure | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily oesophageal pressure | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between parameters of mechanical ventilation and the diaphragm evolution in patients in intensive care | Measurement of the daily O2 inspired fraction. | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the impact of ECMO parameters and the diaphragm evolution in patients in intensive care | Measurement of the daily the daily blood flow | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the impact of ECMO parameters and the diaphragm evolution in patients in intensive care | Measurement of the daily the daily sweep rate | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the impact of ECMO parameters and the diaphragm evolution in patients in intensive care | Measurement of the daily the daily oxygenation | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the impact of ECMO parameters and the diaphragm evolution in patients in intensive care | Measurement of the daily percentage of the theoretical flow | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the impact of ECMO parameters and the diaphragm evolution in patients in intensive care | Measurement of the daily duration of ECMO | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the impact of ECMO parameters and the diaphragm evolution in patients in intensive care | Measurement of the daily the success of weaning. | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the link between the associated organ failures and the diaphragm evolution in patients in intensive care | The daily change in the incidence of diaphragmatic dysfunction defined by the diaphragm thickening fraction <20% during a maximal inspiratory test to J7. The daily collection of hemodynamic variables during the diaphragmatic ultrasound collection including an evaluation of the visual LVEF. | Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7 | 
| To evaluate the impact of the diaphragm evolution on the future of the patient in intensive care: weaning of the assistances, survivals.and the diaphragm | Measurement of the survival | Day 60 | 
| To evaluate the impact of the diaphragm evolution on the future of the patient in intensive care: weaning of the assistances, survivals.and the diaphragm | Measurement of the length of stay in intensive care unit | Day 60 | 
| To evaluate the impact of the diaphragm evolution on the future of the patient in intensive care: weaning of the assistances, survivals.and the diaphragm | Measurement of the failure of extubation | Day 60 | 
| To evaluate the impact of the diaphragm evolution on the future of the patient in intensive care: weaning of the assistances, survivals.and the diaphragm | Measurement of the number of days without mechanical ventilation | Day 60 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ECMO, diaphragm, ICU