A computational framework for adjusting flow during peripheral extracorporeal membrane oxygenation to reduce differential hypoxia

Stevens, Michael C.; Callaghan, Fraser M.; Forrest, Paul; Bannon, Paul G.; Grieve, Stuart M.

doi:10.1016/j.jbiomech.2018.07.037

Cited by 26 publications

(16 citation statements)

References 31 publications

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“…In vivo assessment of these elements is limited by challenges in determining and controlling experimental inputs and measuring and quantifying observed metrics to yield meaningful results. Computational models provide strict control of input variables to yield insight into the multitude of competing and intertwined factors that determine patient-device interactions and enable precise study of the effects of ECMO support on systemic hemodynamics 19,20 . Prior work quantified flow distribution in the ECMO-failing heart circulation using an idealized geometry of the aortofemoral vasculature and analyzed watershed region dynamics over the cardiac cycle 18 .…”

Section: Introductionmentioning

confidence: 99%

Simulation of Fluid-Structure Interaction in Extracorporeal Membrane Oxygenation Circulatory Support Systems

Nezami

Ramezanpour

Khodaee

et al. 2021

J. of Cardiovasc. Trans. Res.

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Extracorporeal membrane oxygenation (ECMO) is a vital mechanical circulatory support modality capable of restoring perfusion for the patient in circulatory failure.Despite increasing adoption of ECMO there is incomplete understanding of its effects on systemic hemodynamics and how the vasculature responds to varying levels of continuous retrograde perfusion. To gain further insight into the complex ECMO:failingheart circulation, computational fluid dynamics simulations focused on perfusion distribution and hemodynamic flow patterns were conducted using a patient-derived aorta geometry. Three case scenarios were simulated: (1) healthy control; (2) 90% ECMO-derived perfusion to model profound heart failure; and, (3) 50% ECMO-derived perfusion to model the recovering heart. Fluid-structure interface simulations were performed to quantify systemic pressure and vascular deformation throughout the aorta over the cardiac cycle. ECMO support alters pressure distribution while decreasing shear stress. Insights derived from computational modeling may lead to better understanding of ECMO support and improved patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Simulation of Fluid-Structure Interaction in Extracorporeal Membrane Oxygenation Circulatory Support Systems

Nezami

Ramezanpour

Khodaee

et al. 2021

J. of Cardiovasc. Trans. Res.

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“…Importantly, the characterisation of an active health digital twin as elucidated in this review is recent, relative to established complex modelling science used to make treatment predictions and inferences in disease, including CVD 38 , 39 . Use of the term digital twin in mechanistic models may be restrained by the absence of the definitive bidirectional data flow with a real patient, due to the extreme complexity required of a model to realistically be able to make such a claim.…”

Section: Discussionmentioning

confidence: 99%

The health digital twin to tackle cardiovascular disease—a review of an emerging interdisciplinary field

et al. 2022

Self Cite

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Potential benefits of precision medicine in cardiovascular disease (CVD) include more accurate phenotyping of individual patients with the same condition or presentation, using multiple clinical, imaging, molecular and other variables to guide diagnosis and treatment. An approach to realising this potential is the digital twin concept, whereby a virtual representation of a patient is constructed and receives real-time updates of a range of data variables in order to predict disease and optimise treatment selection for the real-life patient. We explored the term digital twin, its defining concepts, the challenges as an emerging field, and potentially important applications in CVD. A mapping review was undertaken using a systematic search of peer-reviewed literature. Industry-based participants and patent applications were identified through web-based sources. Searches of Compendex, EMBASE, Medline, ProQuest and Scopus databases yielded 88 papers related to cardiovascular conditions (28%, n = 25), non-cardiovascular conditions (41%, n = 36), and general aspects of the health digital twin (31%, n = 27). Fifteen companies with a commercial interest in health digital twin or simulation modelling had products focused on CVD. The patent search identified 18 applications from 11 applicants, of which 73% were companies and 27% were universities. Three applicants had cardiac-related inventions. For CVD, digital twin research within industry and academia is recent, interdisciplinary, and established globally. Overall, the applications were numerical simulation models, although precursor models exist for the real-time cyber-physical system characteristic of a true digital twin. Implementation challenges include ethical constraints and clinical barriers to the adoption of decision tools derived from artificial intelligence systems.

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“…Differential hypoxaemia corresponds to relative hypoxaemia in the upper body (perfused by the LV) compared to the lower body (perfused by the ECMO). Data regarding DH are lacking, which can be explained by several factors: (1) DH is a highly variable and dynamic condition, (2) multiple factors can contribute to these variations, such as the proportion between native LV and ECMO flows 15,16 , arterial cannula tip position 5 www.nature.com/scientificreports/ venous drainage position 17 , and (3) the carotids of most large animals (bovine, pigs, primates) depart from a common bi-carotid trunk (also known as bovine arch) making cerebral studies during VA ECMO less translatable to humans. As a result, it is unclear if DH creates additional complications by causing cerebral hypoxia 18 or if a relative level of hypoxia is acceptable, as suggested by some authors 19 .…”

Section: Discussionmentioning

confidence: 99%

Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation

Rozencwajg

Heinsar

Wildi

et al. 2023

Sci Rep

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Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain injury in an ovine model of DH. After inducing severe cardiorespiratory failure and providing ECMO support, we randomised six sheep into two groups: low flow (LF) in which ECMO was set at 2.5 L min−1 ensuring that the brain was entirely perfused by the native heart and lungs, and high flow (HF) in which ECMO was set at 4.5 L min−1 ensuring that the brain was at least partially perfused by ECMO. We used invasive (oxygenation tension—PbTO2, and cerebral microdialysis) and non-invasive (near infrared spectroscopy—NIRS) neuromonitoring, and euthanised animals after five hours for histological analysis. Cerebral oxygenation was significantly improved in the HF group as shown by higher PbTO2 levels (+ 215% vs − 58%, p = 0.043) and NIRS (67 ± 5% vs 49 ± 4%, p = 0.003). The HF group showed significantly less severe brain injury than the LF group in terms of neuronal shrinkage, congestion and perivascular oedema (p < 0.0001). Cerebral microdialysis values in the LF group all reached the pathological thresholds, even though no statistical difference was found between the two groups. Differential hypoxaemia can lead to cerebral damage after only a few hours and mandates a thorough neuromonitoring of patients. An increase in ECMO flow was an effective strategy to reduce such damages.

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A computational framework for adjusting flow during peripheral extracorporeal membrane oxygenation to reduce differential hypoxia

Cited by 26 publications

References 31 publications

Simulation of Fluid-Structure Interaction in Extracorporeal Membrane Oxygenation Circulatory Support Systems

Simulation of Fluid-Structure Interaction in Extracorporeal Membrane Oxygenation Circulatory Support Systems

The health digital twin to tackle cardiovascular disease—a review of an emerging interdisciplinary field

Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation

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