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Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study
Univ Utrecht, Univ Med Ctr Utrecht, Dept Intens Care Med, Utrecht, Netherlands..ORCID iD: 0000-0001-6496-2768
Columbia Univ, Coll Phys & Surg, New York Presbyterian Hosp, Div Pulm Allergy & Crit Care Med, New York, NY USA..
Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands..
KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska Univ Hosp, ECMO Dept, SE-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Anaesthesiol & Intens Care, Stockholm, Sweden.
2019 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 65, no 1, p. 11-20Article in journal (Refereed) Published
Abstract [en]

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is widely used in cardiogenic shock. It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated, and effects of various adjunct LV unloading interventions were quantified. After VA ECMO initiation (4 L/min) in cardiogenic shock (baseline), hemodynamics improved (increased to 85 mm Hg), while LV overload occurred (10% increase in end-diastolic volume [EDV], and 5 mm Hg increase in pulmonary capillary wedge pressure [PCWP]). Decreasing afterload (65 mm Hg mean arterial pressure) and circulating volume (-800 mL) reduced LV overload (12% decrease in EDV and 37% decrease in PCWP) compared with baseline. Additional intra-aortic balloon pumping only marginally decreased cardiac loading. Instead, adjunct Impella T enhanced LV unloading (23% decrease in EDV and 41% decrease in PCWP). Alternative interventions, for example, left atrial/ventricular venting, yielded substantial unloading. We conclude that real-time simulations may provide quantitative clinical measures of LV overload, depending on the degree of VA ECMO support and adjunct management. Simulations offer insights into individualized LV unloading interventions in cardiogenic shock supported by VA ECMO as a proof of concept for potential future applications in clinical decision support, which may help to improve individualized patient management in complex cardiovascular disease.

Place, publisher, year, edition, pages
Lippincott Williams and Wilkins , 2019. Vol. 65, no 1, p. 11-20
Keywords [en]
Veno-arterial extracorporeal membrane oxygenation, extracorporeal life support, cardiogenic shock, cardiovascular modeling, computer simulation
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:kth:diva-257468DOI: 10.1097/MAT.0000000000000755ISI: 000480750600007PubMedID: 29517515Scopus ID: 2-s2.0-85047429868OAI: oai:DiVA.org:kth-257468DiVA, id: diva2:1347083
Note

QC 20190830

Available from: 2019-08-30 Created: 2019-08-30 Last updated: 2019-08-30Bibliographically approved

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