OXYGEN DEMAND-SUPPLY RELATIONSHIP IN PERIPHERAL-TISSUES AS A THERAPEUTIC INDICATOR IN ACUTE MYOCARDIAL-INFARCTION WITH ADVANCED HEART-FAILURE

Oxygen demand-supply relationships in peripheral tissues were studied in 14 patients who had acute myocardial infarction with advanced pump failure. Seven patients with acute miocardial infarction but without p ump failure were studied as a control. In all patients, a Swan-Ganz ca theter and a radial arterial cannula were inserted for the purpose of hemodynamic monitoring, and arterial and mixed venous blood were sampl ed. Initially, oxygen delivery (DO2) (p < 0.01) was lower, and oxygen extraction ratio (OER) (p < 0.001) and oxygen tension at 50% saturatio n (P50) (p < 0.01) were higher in patients with pump failure than in t he controls. During the therapeutic course, with an increase in the ca rdiac index and DO2, oxygen uptake (VO2) did not change but OER (p < 0 .001) and P50 (P < 0.01) significantly decreased in 6 survivors with p ump failure. In contrast, an increased VO2 (p < 0.01) and no change of OER and P50 were observed in 8 non-survivors with pump failure. These results suggest that reversibility of oxygenokinetics might be an imp ortant factor for recovery from critical heart failure.