Effect of anatomical variation on extracorporeal membrane oxygenation circulatory support: A computational study

A numerical study of the hemodynamic behavior and gas transport in cardiovascular systems with severe cardiac or cardiopulmonary failure supported by venoarterial extracorporeal membrane oxygenation

“…Methodologically, adopting the 1D modeling method for the arterial system in our study facilitated a detailed simulation of the interaction between blood flow sourced from the native heart and ECMO flow as well as its influence on gas transport in large arteries that are hard to be fully addressed by traditional 0D models ( Zanella et al, 2016 ; Joyce et al, 2018 ). In comparison with existing open-loop 1D or 3D models of the arterial system ( Stevens et al, 2018 ; Feiger et al, 2020 ; Khodaee et al, 2022 ), the closed-loop representation of the entire cardiopulmonary-ECMO system made our model better suited to address the combined effects on systemic hemodynamics and gas transport of the residual native blood circulation capacity, gas exchange/transport in the lung and microcirculations, and ECMO support. The main findings of our study are summarized in Figure 10 and described in detail as follows.…”

“…Existing models can be grouped into several families according to the range of modeling, i.e., local models dedicated to simulating flow patterns in the vicinity of cannulation ( Gu et al, 2016 ; Stevens et al, 2017 ; Conrad and Wang, 2020 ), regional models focused on quantifying ECMO-induced hemodynamic changes in large arteries ( Feiger et al, 2021 ; Seetharaman et al, 2021 ), and global models applied to investigate the impact of ECMO on systemic hemodynamics ( Colasanti et al, 2021 ; Lazzari et al, 2021 ). Moreover, there existed some studies concerned with the transport of oxygenated blood in the cardiovascular system ( Zanella et al, 2016 ; Joyce et al, 2018 ; Stevens et al, 2018 ; Feiger et al, 2020 ; Khodaee et al, 2022 ). These studies provided quantitative evidence for understanding how the oxygenated blood flowing through the ECMO system mixes with the blood in the native cardiovascular system to alter hemodynamic characteristics or improve the status of blood oxygenation in certain arteries or end-organs of concern.…”

“…For instance, the majority of studies, except for a few ones ( Zanella et al, 2016 ; Joyce et al, 2018 ), neglected gas exchanges in the lung, microcirculation, and membrane oxygenator that are important for representing pulmonary dysfunction, metabolic state, and properties of ECMO. Regional models established with one-dimensional or three-dimensional modeling methods had the advantage of simulating in detail the transport of ECMO-oxygenated blood and its interaction with the residual native blood flow in the arterial system ( Stevens et al, 2018 ; Feiger et al, 2020 ; Khodaee et al, 2022 ), but they usually needed the imposition of a blood flow waveform at the aortic root as the inflow boundary conditions, which essentially ignored the role of the dynamic interaction between the residual cardiopulmonary function and ECMO support in determining the characteristics of systemic hemodynamics and gas transport. The deficiency can be addressed by global models, which were generally established with the lumped-parameter modeling method to integrate the heart, complex systemic and pulmonary vasculatures and ECMO into a unique model framework ( Zanella et al, 2016 ; Joyce et al, 2018 ; Colasanti et al, 2021 ; Lazzari et al, 2021 ).…”