Impact of Adrenoreceptor Expressions on Inflammatory Pattern in Refractory Cardiogenic Shock Under VA ECMO

Impact of Adrenoreceptor Expressions on Inflammatory Pattern in Refractory Cardiogenic Shock Patients Treated by Veno-arterial Extra-Corporeal Membrane Oxygenation

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

Inclusion Criteria:

• Patients in ICU

• Refractory cardiogenic shock

  • Cardiogenic shock: Systolic Arterial Pressure <90mmHg, or Mean Arterial Pressure <65mmHg, adequate volemia, peripheral hypoperfusion symptoms, cardiac index < 2.2 l/min/m2)
  • Refractory state: hypo responsiveness to norepinephrine AND/OR persisting profound hypo perfusion clinical symptoms despite optimal resuscitation

• needing an Extra-Corporeal-Life-Support

• informed consent from relatives or patient

• Affiliation to a social security regimen

• Preliminary medical examination

Exclusion Criteria:

• Patients under ECLS for a/an :

  • Cardiotoxic poisoning

• Human immunodeficient Virus or Viral hepatitis C

• Patient < 18 yo

• Pregnancy

• Patient under protective supervision