ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables

Lazzari, Beatrice De; Iacovoni, Attilio; Mottaghy, K.; Capoccia, Massimo; Badagliacca, Roberto; Vizza, Carmine Dario; Lazzari, Claudio De

doi:10.1016/j.cmpb.2021.106003

Cited by 16 publications

(42 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 0-D numerical model described in [7] was used to implement a centrifugal pump that reproduced the behavior of the right ventricular assist device. The pump can be connected in series or parallel to the right ventricle with two cannulae modelled using RLC elements (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…For the purposes of our study, we have assembled the cardiovascular network with the new module of the systemic circulation whilst the behavior of the heart is modelled as described in [3], [4]. The systemic venous section [3], [6] and the entire pulmonary circulation [7], [8], [11], [12] are modelled as described in current literature. We have selected the module presented in [13] for the coronary circulation.…”

Section: The Heart and Circulatory Numerical Networkmentioning

confidence: 99%

See 1 more Smart Citation

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Lazzari

Iacovoni

Capoccia

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background and Objective: The main indications for right ventricular assist device (RVAD) support are right heart failure after implantation of a left ventricular assist device (LVAD) or early graft failure following heart transplantation. About 30-40% of patients will need RVAD support after LVAD implantation. Pulmonary hypertension is also an indication for right heart assistance. Several types of RVAD generating pulsatile or continuous flow are available on the market. These assist devices can be connected to the cardiovascular system in different ways. We sought to analyse the effects induced by different RVAD connections when right ventricular elastance is modified using a numerical simulator. The analysis was based on the behaviour of both left and right ventricular and atrial loops in the pressure-volume plane. Methods: New modules of the cardiovascular network and a right ventricular centrifugal pump were implemented in CARDIOSIM software simulator platform. The numerical pump model generated continuous flow when connected in series or parallel to the right ventricle. When the RVAD was connected in series (parallel), the pump removed blood from the right ventricle (atrium) and ejected it into the pulmonary artery. In our study, we analysed the effects induced by RVAD support on left/right ventricular/atrial loops when right ventricular elastance slope (EesRIGHT) changed from 0.3 to 0.8 mmHg/ml with the pump connected either in series or parallel. The effect of low and high rotational pump speed was also addressed. Results: Percentage changes up to 60% were observed for left ventricular pressure-volume area and external work during in-parallel RVAD support at 4000 rpm with EesRIGHT = 0.3mmHg/ml. The same pump setting and connection type led to percentage variation up to 20% for left ventricular ESV and up to 25% for left ventricular EDV with EesRIGHT = 0.3mmHg/ml. Again the same pump setting and connection generated up to 50% change in left atrial pressure-volume loop area (PVLAL-A ) and only 3% change in right atrial pressure-volume loop area (PVLAR-A) when EesRIGHT = 0.3mmHg/ml. Percentage variation was lower when EesRIGHT was increased up to 0.8 mmHg/ml. Conclusion: Early recognition of right ventricular failure followed by aggressive treatment is desirable to achieve a more favourable outcome. RVAD support remains an option for advanced right ventricular failure although onset of major adverse events may preclude its use.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: The Heart and Circulatory Numerical Networkmentioning

confidence: 99%

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Lazzari

Iacovoni

Capoccia

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition, the software platform is suitable for carrying out various studies focused on the interaction between the cardiovascular system, mechanical ventilatory support and mechanical circulatory assist devices (MCADs) [ 12 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ].…”

Section: Methodsmentioning

confidence: 99%

CARDIOSIM©: The First Italian Software Platform for Simulation of the Cardiovascular System and Mechanical Circulatory and Ventilatory Support

et al. 2022

Self Cite

View full text Add to dashboard Cite

This review is devoted to presenting the history of the CARDIOSIM© software simulator platform, which was developed in Italy to simulate the human cardiovascular and respiratory systems. The first version of CARDIOSIM© was developed at the Institute of Biomedical Technologies of the National Research Council in Rome. The first platform version published in 1991 ran on a PC with a disk operating system (MS-DOS) and was developed using the Turbo Basic language. The latest version runs on PC with Microsoft Windows 10 operating system; it is implemented in Visual Basic and C++ languages. The platform has a modular structure consisting of seven different general sections, which can be assembled to reproduce the most important pathophysiological conditions. One or more zero-dimensional (0-D) modules have been implemented in the platform for each section. The different modules can be assembled to reproduce part or the whole circulation according to Starling’s law of the heart. Different mechanical ventilatory and circulatory devices have been implemented in the platform, including thoracic artificial lungs, ECMO, IABPs, pulsatile and continuous right and left ventricular assist devices, biventricular pacemakers and biventricular assist devices. CARDIOSIM© is used in clinical and educational environments.

show abstract

“…ECMO is a medical technology that has two applications: for cardiovascular support (by venous-arterial (V-A) cannulation) and for treatment of acute respiratory failure (by veno-venous (V-V) cannulation). An enormous increase of ECMO centers in recent years was observed [42] and in order to increase patients' safety and to optimize ECMO efficacy, both training simulators as well as hybrid simulators are needed [43][44][45][46][47][48]. The simulators can help in ECMO system training, enabling, in some cases, high fidelity clinical scenarios [43,44] or to study the hemodynamic effect of ECMO on the left ventricular loading in a V-A configuration and the parasitic effect of blood recirculation in V-V cannulation [46].…”

Section: Approaches To Cardiovascular and Respiratory Systems Modellingmentioning

confidence: 99%

“…To accurately test physical devices for ventilatory or cardiac support, an artificial patient has to contain an accurate model of the RS with pulmonary circulation, which can simulate such phenomena that are important for blood saturations as ventilation-perfusion mismatch or influence of obstructive lung diseases of any severity on the CVS work, for example. The artificial patient applied by the authors has this potential [51], which led to the creation of the CARDIOSIM© simulator [28,29,48], which can be used in medical devices testing [8]. As the numerical components of this artificial patient are 0D models, in general, they cannot be used in investigations of phenomena at the microscale, such as turbulences in air and blood flows, for example.…”

Section: Approaches To Cardiovascular and Respiratory Systems Modellingmentioning

confidence: 99%

Virtual and Artificial Cardiorespiratory Patients in Medicine and Biomedical Engineering

et al. 2022

View full text Add to dashboard Cite

Recently, ‘medicine in silico’ has been strongly encouraged due to ethical and legal limitations related to animal experiments and investigations conducted on patients. Computer models, particularly the very complex ones (virtual patients—VP), can be used in medical education and biomedical research as well as in clinical applications. Simpler patient-specific models may aid medical procedures. However, computer models are unfit for medical devices testing. Hybrid (i.e., numerical–physical) models do not have this disadvantage. In this review, the chosen approach to the cardiovascular system and/or respiratory system modeling was discussed with particular emphasis given to the hybrid cardiopulmonary simulator (the artificial patient), that was elaborated by the authors. The VP is useful in the education of forced spirometry, investigations of cardiopulmonary interactions (including gas exchange) and its influence on pulmonary resistance during artificial ventilation, and explanation of phenomena observed during thoracentesis. The artificial patient is useful, inter alia, in staff training and education, investigations of cardiorespiratory support and the testing of several medical devices, such as ventricular assist devices and a membrane-based artificial heart.

show abstract

ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables

Cited by 16 publications

References 27 publications

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

Ventricular and Atrial Pressure-Volume Loops: Analysis of the Effects Induced by Right Centrifugal Pump Assistance

CARDIOSIM©: The First Italian Software Platform for Simulation of the Cardiovascular System and Mechanical Circulatory and Ventilatory Support

Virtual and Artificial Cardiorespiratory Patients in Medicine and Biomedical Engineering

Contact Info

Product

Resources

About