PMID- 29517515
OWN - NLM
STAT- MEDLINE
DCOM- 20200210
LR  - 20200306
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Print)
IS  - 1058-2916 (Linking)
VI  - 65
IP  - 1
DP  - 2019 Jan
TI  - Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study.
PG  - 11-20
LID - 10.1097/MAT.0000000000000755 [doi]
AB  - 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 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.
FAU - Donker, Dirk W
AU  - Donker DW
AD  - From the Department of Intensive Care Medicine, University Medical Center 
      Utrecht, Utrecht University, The Netherlands.
FAU - Brodie, Daniel
AU  - Brodie D
AD  - Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University 
      College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New 
      York.
FAU - Henriques, Jose P S
AU  - Henriques JPS
AD  - Department of Cardiology, Academic Medical Center, University of Amsterdam, 
      Amsterdam, The Netherlands.
FAU - Broome, Michael
AU  - Broome M
AD  - ECMO Department, Karolinska University Hospital, Stockholm, Sweden.
AD  - Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, 
      Karolinska Institute, Stockholm, Sweden.
AD  - School of Technology and Health, Royal Institute of Technology, Stockholm, 
      Sweden.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Animals
MH  - *Computer Simulation
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Heart Ventricles/physiopathology
MH  - Hemodynamics/physiology
MH  - Humans
MH  - *Models, Cardiovascular
MH  - Shock, Cardiogenic/physiopathology/therapy
PMC - PMC6325768
EDAT- 2018/03/09 06:00
MHDA- 2020/02/11 06:00
PMCR- 2019/01/09
CRDT- 2018/03/09 06:00
PHST- 2018/03/09 06:00 [pubmed]
PHST- 2020/02/11 06:00 [medline]
PHST- 2018/03/09 06:00 [entrez]
PHST- 2019/01/09 00:00 [pmc-release]
AID - 10.1097/MAT.0000000000000755 [doi]
PST - ppublish
SO  - ASAIO J. 2019 Jan;65(1):11-20. doi: 10.1097/MAT.0000000000000755.