Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study (2024)

Donker, D. W., Brodie, D., Henriques, J. P. S., & Broomé, M. (2019). Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study. ASAIO journal, 65(1), 11-20. https://doi.org/10.1097/MAT.0000000000000755

Donker, Dirk W. ; Brodie, Daniel ; Henriques, José P.S. et al. / Left Ventricular Unloading During Veno-Arterial ECMO : A Simulation Study. In: ASAIO journal. 2019 ; Vol. 65, No. 1. pp. 11-20.

@article{b5289b7aaf934e59bd037289dbb141e8,

title = "Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study",

abstract = "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{\texttrademark} 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.",

keywords = ".",

author = "Donker, {Dirk W.} and Daniel Brodie and Henriques, {Jos{\'e} P.S.} and Michael Broom{\'e}",

note = "Publisher Copyright: Copyright {\textcopyright} 2018 The Author(s). Published by Wolters Kluwer Health,nc.",

year = "2019",

month = jan,

day = "1",

doi = "10.1097/MAT.0000000000000755",

language = "English",

volume = "65",

pages = "11--20",

journal = "ASAIO journal",

issn = "1058-2916",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Donker, DW, Brodie, D, Henriques, JPS & Broomé, M 2019, 'Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study', ASAIO journal, vol. 65, no. 1, pp. 11-20. https://doi.org/10.1097/MAT.0000000000000755

Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study. / Donker, Dirk W.; Brodie, Daniel; Henriques, José P.S. et al.
In: ASAIO journal, Vol. 65, No. 1, 01.01.2019, p. 11-20.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Left Ventricular Unloading During Veno-Arterial ECMO

T2 - A Simulation Study

AU - Donker, Dirk W.

AU - Brodie, Daniel

AU - Henriques, José P.S.

AU - Broomé, Michael

N1 - Publisher Copyright:Copyright © 2018 The Author(s). Published by Wolters Kluwer Health,nc.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

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.

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U2 - 10.1097/MAT.0000000000000755

DO - 10.1097/MAT.0000000000000755

M3 - Article

C2 - 29517515

SN - 1058-2916

VL - 65

SP - 11

EP - 20

JO - ASAIO journal

JF - ASAIO journal

IS - 1

ER -

Donker DW, Brodie D, Henriques JPS, Broomé M. Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study. ASAIO journal. 2019 Jan 1;65(1):11-20. Epub 2018. doi: 10.1097/MAT.0000000000000755