A simulation study of left ventricular decompression using a double lumen arterial cannula prototype during a veno-arterial extracorporeal membrane oxygenation

Ježek, Filip; Strunina, Svitlana; Carlson, Brian E.; Hozman, Jiřı́

doi:10.1177/0391398819858084

Cited by 2 publications

(2 citation statements)

References 31 publications

(56 reference statements)

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“…Flow mixing and left ventricular decompression in veno-atrial ECMO (VA ECMO) have also been modeled to improve patient outcomes. 19,20 These studies show the influence of CFD in understanding and improving the ECMO device.…”

Section: Introductionmentioning

confidence: 93%

“…Some findings were consistent with experimental and clinical findings, while others have not been previously studied. Flow mixing and left ventricular decompression in veno‐atrial ECMO (VA ECMO) have also been modeled to improve patient outcomes 19,20 . These studies show the influence of CFD in understanding and improving the ECMO device.…”

Section: Introductionmentioning

confidence: 99%

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Optical, flow, and thermal analysis of a phototherapy extracorporeal membrane oxygenator for treating carbon monoxide poisoning

et al. 2023

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Background Extracorporeal membrane oxygenators (ECMO) are currently utilized to mechanically ventilate blood when lung or lung and heart function are impaired, like in cases of acute respiratory distress syndrome (ARDS). ARDS can be caused by severe cases of carbon monoxide (CO) inhalation, which is the leading cause of poison‐related deaths in the United States. ECMOs can be further optimized for severe CO inhalation using visible light to photo‐dissociate CO from hemoglobin (Hb). In previous studies, we combined phototherapy with an ECMO to design a photo‐ECMO device, which significantly increased CO elimination and improved survival in CO‐poisoned animal models using light at 460, 523, and 620 nm wavelengths. Light at 620 nm was the most effective in removing CO. Objective The aim of this study is to analyze the light propagation at 460, 523, and 620 nm wavelengths and the 3D blood flow and heating distribution within the photo‐ECMO device that increased CO elimination in CO‐poisoned animal models. Methods Light propagation, blood flow dynamics, and heat diffusion were modeled using the Monte Carlo method and the laminar Navier‐Stokes and heat diffusion equations, respectively. Results Light at 620 nm propagated through the device blood compartment (4 mm), while light at 460 and 523 nm only penetrated 48% to 50% (~2 mm). The blood flow velocity in the blood compartment varied with regions of high (5 mm/s) and low (1 mm/s) velocity, including stagnant flow. The blood temperatures at the device outlet for 460, 523, and 620 nm wavelengths were approximately 26.7°C, 27.4°C, and 20°C, respectively. However, the maximum temperatures within the blood treatment compartment rose to approximately 71°C, 77°C, and 21°C, respectively. Conclusions As the extent of light propagation correlates with efficiency in photodissociation, the light at 620 nm is the optimal wavelength for removing CO from Hb while maintaining blood temperatures below thermal damage. Measuring the inlet and outlet blood temperatures is not enough to avoid unintentional thermal damage by light irradiation. Computational models can help eliminate risks of excessive heating and improve device development by analyzing design modifications that improve blood flow, like suppressing stagnant flow, further increasing the rate of CO elimination.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Optical, flow, and thermal analysis of a phototherapy extracorporeal membrane oxygenator for treating carbon monoxide poisoning

et al. 2023

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Left ventricular unloading and the role of ECpella

Bělohlávek

Hunziker

Donker

2021

European Heart Journal Supplements

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The main reason for the emergency implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is the restoration of adequate systemic perfusion, while protecting the failing heart and promoting myocardial recovery are equally important goals. Following initial haemodynamic stabilization and often the urgent revascularization of the culprit lesion, the clinical focus is then directed towards the most efficient strategy for cardioprotection. Frequent echocardiography measurements may help to estimate the degree of unwanted left ventricular (LV) overloading during VA-ECMO. Additionally, the estimation of high LV filling pressures by Doppler echocardiography or their (in-)direct measurement using a dedicated surgical left atrial pressure line and conventional pulmonary artery catheter in a wedge position or a pigtail catheter in the left ventricle can be performed. Mechanical overload of the left ventricle is the major adverse effect and an obvious mechanistic and prognostic challenge of contemporary ECMO care. Many efforts are under way to overcome this phenomenon by LV unloading, which was effectively achieved by the current combined approach using an axial decompression device, while novel technical developments and approaches are tested and urgently anticipated. The aim of this report is to introduce in depth pathophysiological background, current concepts, and future perspectives in LV unloading strategies.

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A simulation study of left ventricular decompression using a double lumen arterial cannula prototype during a veno-arterial extracorporeal membrane oxygenation

Cited by 2 publications

References 31 publications

Optical, flow, and thermal analysis of a phototherapy extracorporeal membrane oxygenator for treating carbon monoxide poisoning

Optical, flow, and thermal analysis of a phototherapy extracorporeal membrane oxygenator for treating carbon monoxide poisoning

Left ventricular unloading and the role of ECpella

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