Determining the impacts of venoarterial extracorporeal membrane oxygenation on cerebral oxygenation using a one-dimensional blood flow simulator

Feiger, Bradley; Kochar, Ajar; Gounley, John; Bonadonna, Desiree; Daneshmand, Mani A.; Randles, Amanda

doi:10.1016/j.jbiomech.2020.109707

Cited by 15 publications

(21 citation statements)

References 48 publications

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“…Hence, lumped parameter models are the right tool for answering research questions regarding distribution of oxygen. Yet, it is possible to include oxygen distribution in 1D models ( 96 ), but it has not been applied in fetal 1D models.…”

Section: Discussionmentioning

confidence: 99%

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

et al. 2022

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BackgroundPreterm birth is the main cause of neonatal deaths with increasing mortality and morbidity rates with decreasing GA at time of birth. Currently, premature infants are treated in neonatal intensive care units to support further development. However, the organs of, especially, extremely premature infants (born before 28 weeks of GA) are not mature enough to function optimally outside the womb. This is seen as the main cause of the high morbidity and mortality rates in this group. A liquid-filled incubator, a so-called PLS system, could potentially improve these numbers for extremely premature infants, since this system is designed to mimic the environment of the natural womb. To support the development and implementation of such a complex system and to interpret vital signals of the fetus during a PLS system operation, a digital twin is proposed. This mathematical model is connected with a manikin representing the digital and physical twin of the real-life PLS system. Before developing a digital twin of a fetus in a PLS system, its functional and technical requirements are defined and existing mathematical models are evaluated.Method and resultsThis review summarizes existing 0D and 1D fetal circulatory models that potentially could be (partly) adopted for integration in a digital twin of a fetus in a PLS system based on predefined requirements. The 0D models typically describe hemodynamics and/or oxygen transport during specific events, such as the transition from fetus to neonate. Furthermore, these models can be used to find hemodynamic differences between healthy and pathological physiological states. Rather than giving a global description of an entire cardiovascular system, some studies focus on specific organs or vessels. In order to analyze pressure and flow wave profiles in the cardiovascular system, transmission line or 1D models are used. As for now, these models do not include oxygen transport.ConclusionThis study shows that none of the models identified in literature meet all the requirements relevant for a digital twin of a fetus in a PLS system. Nevertheless, it does show the potential to develop this digital twin by integrating (parts) of models into a single model.

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Section: Discussionmentioning

confidence: 99%

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

et al. 2022

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“…Analyses presented demonstrated that lower LV oxygenation resulted in more extreme hypoxia to the cerebral vessels [ 21 ]. The final study is by Feiger et al where adjustment of the ECMO cannula site predicted changes in blood flow over a 1D model of the cardiovascular system [ 22 ]. Sites analyzed were axillary, central, and two femoral configurations.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO

Prisco

Aguado-Sierra

Butakoff

et al. 2021

J. of Cardiovasc. Trans. Res.

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Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for acute cardiogenic shock in patients who also have acute lung injury predisposes development of a serious complication called “north-south syndrome” (NSS) which causes cerebral hypoxia. NSS is poorly characterized and hemodynamic studies have focused on cerebral perfusion ignoring the heart. We hypothesized in NSS the heart would be more likely to receive hypoxemic blood than the brain due to the proximity of the coronary arteries to the aortic annulus. To test this, we conducted a computational fluid dynamics simulation of blood flow in a human supported by VA-ECMO. Simulations quantified the fraction of blood at each aortic branching vessel originating from residual native cardiac output versus VA-ECMO. As residual cardiac function was increased, simulations demonstrated myocardial hypoxia would develop prior to cerebral hypoxia. These results illustrate the conditions where NSS will develop and the relative cardiac function that will lead to organ-specific hypoxia. Graphical Abstract

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“…We used a 1D blood flow model described in (36,37). The 1D blood flow simulator was based on the following governing equations:…”

Section: Mathematical Formulationmentioning

confidence: 99%

“…where A is vessel cross-sectional area, Q is flow rate, P is pressure, r is density of blood, a describes the velocity profile, and C f ¼ 22pm is a frictional term. a and C f were estimated from experimental data that have been used in 1D models (36)(37)(38)(39). P and A are related by the following constitutive equation:…”

Section: Mathematical Formulationmentioning

confidence: 99%

Analysis identifying minimal governing parameters for clinically accurate in silico fractional flow reserve

Tanade

Chen²,

Leopold³

et al. 2022

Front. Med. Technol.

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BackgroundPersonalized hemodynamic models can accurately compute fractional flow reserve (FFR) from coronary angiograms and clinical measurements (FFRbaseline), but obtaining patient-specific data could be challenging and sometimes not feasible. Understanding which measurements need to be patient-tuned vs. patient-generalized would inform models with minimal inputs that could expedite data collection and simulation pipelines.AimsTo determine the minimum set of patient-specific inputs to compute FFR using invasive measurement of FFR (FFRinvasive) as gold standard.Materials and MethodsPersonalized coronary geometries (N=50) were derived from patient coronary angiograms. A computational fluid dynamics framework, FFRbaseline, was parameterized with patient-specific inputs: coronary geometry, stenosis geometry, mean arterial pressure, cardiac output, heart rate, hematocrit, and distal pressure location. FFRbaseline was validated against FFRinvasive and used as the baseline to elucidate the impact of uncertainty on personalized inputs through global uncertainty analysis. FFRstreamlined was created by only incorporating the most sensitive inputs and FFRsemi-streamlined additionally included patient-specific distal location.ResultsFFRbaseline was validated against FFRinvasive via correlation (r=0.714, p<0.001), agreement (mean difference: 0.01±0.09), and diagnostic performance (sensitivity: 89.5%, specificity: 93.6%, PPV: 89.5%, NPV: 93.6%, AUC: 0.95). FFRsemi-streamlined provided identical diagnostic performance with FFRbaseline. Compared to FFRbaseline vs. FFRinvasive, FFRstreamlined vs. FFRinvasive had decreased correlation (r=0.64, p<0.001), improved agreement (mean difference: 0.01±0.08), and comparable diagnostic performance (sensitivity: 79.0%, specificity: 90.3%, PPV: 83.3%, NPV: 87.5%, AUC: 0.90).ConclusionStreamlined models could match the diagnostic performance of the baseline with a full gamut of patient-specific measurements. Capturing coronary hemodynamics depended most on accurate geometry reconstruction and cardiac output measurement.

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Determining the impacts of venoarterial extracorporeal membrane oxygenation on cerebral oxygenation using a one-dimensional blood flow simulator

Cited by 15 publications

References 48 publications

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

A review study of fetal circulatory models to develop a digital twin of a fetus in a perinatal life support system

Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO

Analysis identifying minimal governing parameters for clinically accurate in silico fractional flow reserve

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