Cardiovascular

Gastric tonometry in cardiogenic shock: Case report

Janssens U, MD FESC
Medical Clinic I
University of Aachen Germany

Email: ujanssens@post.klinikum.rwth-aachen.de

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A 73 year old woman was admitted to a district hospital due to acute anterior myocardial infarction within the scope of which she developed incessant ventricular tachycardia (VT), which could not be corrected with drugs or electrical cardioversion. Therefore the intubated and ventilated patient was transferred to our ICU for further diagnostic and therapeutic procedures.

A transesophageal echocardiography revealed a severely reduced left ventricular function (ejection fraction 18%) as well as an aneurysm of the left ventricular anterior wall. Hemodynamic monitoring was performed with a pulmonary artery catheter. Moreover, gastric PCO2 was measured semicontinuously with the Tonocap Monitor. Coronary angiography revealed an occluded left anterior descending artery. Recanalisation was unsuccessful. The patient remained in cardiogenic shock with a cardiac index below 2.2 l/min/m2. VT was still present with a heart rate of about 140 beats/min. Although hemodynamic parameters (cardiac index, oxygen delivery index and oxygen consumption index) did not change, gastric CO2 (PgCO2) as well as gastric CO2 / arterial CO2 gap P(g-a) CO2 deteriorated over the next several hours as shown on the graphs thus reflecting progressive hypoperfusion of the gut. Therefore, we decided to perform emergency catheter ablation by delivering radio frequency energy over an endocardial mapping / ablation catheter placed in the endocardial region of the left ventricle in the zone of slow conduction responsible for the VT. Ablation therapy was successful and the patient regained sinus rhythm. Thereafter, PgCO2 as well as P(g-a)CO2 normalized.

This case clearly demonstrates that prolonged low cardiac output failure in a patient with incessant VT and severely reduced left ventricular function is associated with a significant hypoperfusion of the gastrointestinal mucosa as demonstrated by increasing PgCO2 in our patient. Although our decision to perform emergency catheter ablation was not solely based on these data, increasing PgCO2 and P(g-a)CO2 in our patient provided further evidence that tonometry may serve as an early indicator for severe hypoperfusion of the gastric mucosal tissue in patients with cardiogenic shock and may therefore support therapeutic decisions.

Last updated: 1 December 2002Created
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