PMID- 30104052
OWN - NLM
STAT- MEDLINE
DCOM- 20190528
LR  - 20190528
IS  - 1873-2380 (Electronic)
IS  - 0021-9290 (Linking)
VI  - 79
DP  - 2018 Oct 5
TI  - A computational framework for adjusting flow during peripheral extracorporeal 
      membrane oxygenation to reduce differential hypoxia.
PG  - 39-44
LID - S0021-9290(18)30631-6 [pii]
LID - 10.1016/j.jbiomech.2018.07.037 [doi]
AB  - Peripheral veno-arterial extra corporeal membrane oxygenation (VA-ECMO) is an 
      established technique for short-to-medium support of patients with severe cardiac 
      failure. However, in patients with concomitant respiratory failure, the residual 
      native circulation will provide deoxygenated blood to the upper body, and may 
      cause differential hypoxemia of the heart and brain. In this paper, we present a 
      general computational framework for the identification of differential hypoxemia 
      risk in VA-ECMO patients. A range of different VA-ECMO patient scenarios for a 
      patient-specific geometry and vascular resistance were simulated using transient 
      computational fluid dynamics simulations, representing a clinically relevant 
      range of values of stroke volume and ECMO flow. For this patient, regardless of 
      ECMO flow rate, left ventricular stroke volumes greater than 28 mL resulted in 
      all aortic arch branch vessels being perfused by poorly-oxygenated systemic blood 
      sourced from the lungs. The brachiocephalic artery perfusion was almost entirely 
      derived from blood from the left ventricle in all scenarios except for those with 
      stroke volumes less than 5 mL. Our model therefore predicted a strong risk of 
      differential hypoxemia in nearly all situations with some residual cardiac 
      function for this combination of patient geometry and vascular resistance. This 
      simulation highlights the potential value of modelling for optimising ECMO design 
      and procedures, and for the practical utility for personalised approaches in the 
      clinical use of ECMO.
CI  - Copyright (c) 2018 Elsevier Ltd. All rights reserved.
FAU - Stevens, Michael Charles
AU  - Stevens MC
AD  - Sydney Translational Imaging Laboratory, Heart Research Institute, Charles 
      Perkins Centre, University of Sydney, Australia; Graduate School of Biomedical 
      Engineering, University of New South Wales, Sydney, Australia; Sydney Medical 
      School, University of Sydney, Camperdown, Australia.
FAU - Callaghan, Fraser M
AU  - Callaghan FM
AD  - Sydney Translational Imaging Laboratory, Heart Research Institute, Charles 
      Perkins Centre, University of Sydney, Australia; Sydney Medical School, 
      University of Sydney, Camperdown, Australia.
FAU - Forrest, Paul
AU  - Forrest P
AD  - Sydney Medical School, University of Sydney, Camperdown, Australia; Department of 
      Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia; 
      Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.
FAU - Bannon, Paul G
AU  - Bannon PG
AD  - Sydney Medical School, University of Sydney, Camperdown, Australia; Institute of 
      Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird 
      Institute, Sydney, Australia.
FAU - Grieve, Stuart M
AU  - Grieve SM
AD  - Sydney Translational Imaging Laboratory, Heart Research Institute, Charles 
      Perkins Centre, University of Sydney, Australia; Sydney Medical School, 
      University of Sydney, Camperdown, Australia; Department of Radiology, Royal 
      Prince Alfred Hospital, Camperdown, Australia. Electronic address: 
      stuart.grieve@sydney.edu.au.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180731
PL  - United States
TA  - J Biomech
JT  - Journal of biomechanics
JID - 0157375
SB  - IM
MH  - Adult
MH  - *Extracorporeal Membrane Oxygenation
MH  - Heart Failure/*complications/therapy
MH  - Humans
MH  - Hydrodynamics
MH  - Hypoxia/*etiology
MH  - Male
MH  - *Models, Cardiovascular
MH  - Respiratory Insufficiency/*complications
OTO - NOTNLM
OT  - Computational fluid dynamics
OT  - ECMO
OT  - Extracorporeal circulation
OT  - Heart failure
OT  - Mechanical circulatory support
EDAT- 2018/08/15 06:00
MHDA- 2019/05/29 06:00
CRDT- 2018/08/15 06:00
PHST- 2018/01/11 00:00 [received]
PHST- 2018/06/29 00:00 [revised]
PHST- 2018/07/24 00:00 [accepted]
PHST- 2018/08/15 06:00 [pubmed]
PHST- 2019/05/29 06:00 [medline]
PHST- 2018/08/15 06:00 [entrez]
AID - S0021-9290(18)30631-6 [pii]
AID - 10.1016/j.jbiomech.2018.07.037 [doi]
PST - ppublish
SO  - J Biomech. 2018 Oct 5;79:39-44. doi: 10.1016/j.jbiomech.2018.07.037. Epub 2018 
      Jul 31.