Individualized real-time clinical decision support to monitor cardiac loading during venoarterial ECMO

Abstract

Veno-arterial extracoporeal membrane oxygenation (VA ECMO) is increasingly used for acute and refractory cardiogenic shock. Yet, in clinical practice, monitoring of cardiac loading conditions during VA ECMO can be cumbersome. To this end, we illustrate the validity and clinical applicability of a real-time cardiovascular computer simulation, which allows to integrate hemodynamics, cardiac dimensions and the corresponding degree of VA ECMO support and ventricular loading in individual patients over time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0760-1) contains supplementary material, which is available to authorized users.

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

“…The nature of cardiac failure (ie, isolated left, vs isolated right, vs biventricular heart failure) was not incorporated into this model. Since ECMO may hamper left ventricular unloading and worsen left ventricular pressure/volume relations, the presence of predominant left ventricular failure in patients on va‐ECMO support may be associated with worse outcome. To study this hypothesis, we investigated outcome according to the presence of isolated left, vs isolated right, vs biventricular heart failure.…”

Model-Based Weaning Tests for VA-ECLS Therapy

“…Mathematical models of biological or physiological systems have proved their ability to provide a better understanding of the basic mechanisms at work in many complex situations. In particular, many mathematical models of the cardiovascular system have already been proposed and analyzed in literature [5][6][7][8][9][10][11][12][13][14]. However, only a few have studied the interactions between the cardiovascular system and an extracorporeal circulatory support device [5,12].…”

“…In particular, many mathematical models of the cardiovascular system have already been proposed and analyzed in literature [5][6][7][8][9][10][11][12][13][14]. However, only a few have studied the interactions between the cardiovascular system and an extracorporeal circulatory support device [5,12]. In [5], Broomé and Donker have built a rather complex cardiovascular model connected to a VA-ECLS, with 32 compartments for the cardiovascular system and 1 compartment describing the ECLS.…”

“…However, only a few have studied the interactions between the cardiovascular system and an extracorporeal circulatory support device [5,12]. In [5], Broomé and Donker have built a rather complex cardiovascular model connected to a VA-ECLS, with 32 compartments for the cardiovascular system and 1 compartment describing the ECLS. Given the usually rather low number of measurements available in the ICU, a rather large number of the many parameters of this model cannot be determined in a patient-specific way.…”

“…The values of the parameters and the comparison between the model and the experimental data are analyzed, and we explain that our work can be considered a first encouraging step towards the development of in silico weaning tests from a VA-ECLS. We also compare our simplified model with another model [5] presented in literature. Finally, a conclusion and possible future work are presented.…”