Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock

Ošťádal, Petr; Mlček, Mikuláš; Gorhan, Holger; Simundic, Ivo; Strunina, Svitlana; Hrachovina, Matěj; Krüger, Andreas; Vondráková, Dagmar; Janotka, Marek; Hála, Pavel; Mates, Martin; Ošťádal, Martin; Leiter, James C.; Kittnar, O; Neužil, Petr

doi:10.1371/journal.pone.0196321

Cited by 34 publications

(53 citation statements)

References 29 publications

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“…Systolic ejection trended to maximum at middle levels and to minimum at the highest levels of VA ECMO support. Such a trend was not observed in acute cardiogenic shock model induced by regional myocardial hypoxemia where ejection continued to decline [8] but was observed in another model of global myocardial hypoxia supported by stepwise VA ECMO [49]. Interestingly, in the latter work, this trend was observed regardless of pulsatile or non-pulsatile ECMO flows.…”

Section: Discussionmentioning

confidence: 73%

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

et al. 2020

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Background: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in the treatment of circulatory failure, but repeatedly, its negative effects on the left ventricle (LV) have been observed. The purpose of this study is to assess the influence of increasing extracorporeal blood flow (EBF) on LV performance during VA ECMO therapy of decompensated chronic heart failure. Methods: A porcine model of low-output chronic heart failure was developed by long-term fast cardiac pacing. Subsequently, under total anesthesia and artificial ventilation, VA ECMO was introduced to a total of five swine with profound signs of chronic cardiac decompensation. LV performance and organ specific parameters were recorded at different levels of EBF using a pulmonary artery catheter, a pressure-volume loop catheter positioned in the LV, and arterial flow probes on systemic arteries. Results: Tachycardia-induced cardiomyopathy led to decompensated chronic heart failure with mean cardiac output of 2.9 ± 0.4 L/min, severe LV dilation, and systemic hypoperfusion. By increasing the EBF from minimal flow to 5 L/min, we observed a gradual increase of LV peak pressure from 49 ± 15 to 73 ± 11 mmHg (P = 0.001) and an improvement in organ perfusion. On the other hand, cardiac performance parameters revealed higher demands put on LV function: LV end-diastolic pressure increased from 7 ± 2 to 15 ± 3 mmHg, end-diastolic volume increased from 189 ± 26 to 218 ± 30 mL, end-systolic volume increased from 139 ± 17 to 167 ± 15 mL (all P < 0.001), and stroke work increased from 1434 ± 941 to 1892 ± 1036 mmHg*mL (P < 0.05). LV ejection fraction and isovolumetric contractility index did not change significantly. Conclusions: In decompensated chronic heart failure, excessive VA ECMO flow increases demands and has negative effects on the workload of LV. To protect the myocardium from harm, VA ECMO flow should be adjusted with respect to not only systemic perfusion, but also to LV parameters.

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Section: Discussionmentioning

confidence: 73%

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

et al. 2020

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“…In a cardiogenic shock model, synchronized pulsatile flow was correlated with significant reduction of left ventricular end‐systolic volume, with an increased left ventricular stroke volume, and higher ejection fraction at flow rates of 1, 1.5, 2, 2.5, 3, 3.5, and 4 L/min compared with non‐pulsatile flow . In a separate study using the same pump, coronary artery blood flow was significantly increased with pulsatile perfusion during ventricular fibrillation in vivo .…”

Section: Discussionmentioning

confidence: 83%

Novel ECG-Synchronized Pulsatile ECLS System With Various Heart Rates and Cardiac Arrhythmias: An In Vitro Study

Wang

Spencer

Kunselman³

et al. 2017

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The objective of this study is to evaluate electrocardiography (ECG)-synchronized pulsatile flow under varying heart rates and different atrial and ventricular arrhythmias in a simulated extracorporeal life support (ECLS) system. The ECLS circuit consisted of an i-cor diagonal pump and console, an iLA membrane ventilator, and an 18 Fr arterial cannula. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). An ECG simulator was used to trigger pulsatile flow and to generate selected cardiac rhythms. All trials were conducted at a flow rate of 2.5 L/min at room temperature for normal sinus rhythm at 45-180 bpm under non-pulsatile and pulsatile modes. Various atrial and ventricular arrhythmias were also tested. Real-time pressure and flow data were recorded using a custom-based data acquisition system. The energy equivalent pressure (EEP) generated by pulsatile flow was always higher than the mean pressure. No surplus hemodynamic energy (SHE) was recorded under non-pulsatile mode. Under pulsatile mode, SHE levels increased with increasing heart rates (45-120 bpm). SHE levels under a 1:2 assist ratio were higher than the 1:1 and 1:3 assist ratios with a heart rate of 180 bpm. A similar trend was recorded for total hemodynamic energy levels. There was no statistical difference between the two perfusion modes with regards to pressure drops across the ECLS circuit. The main resistance and energy loss came from the arterial cannula. The i-cor console successfully tracked electrocardiographic signals of 12 atrial and ventricular arrhythmias. Our results demonstrated that the i-cor pulsatile ECLS system can be synchronized with a normal heart rate or with various atrial/ventricular arrhythmias. Further in vivo studies are warranted to confirm our findings.

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“…Dr. Ostadal and his colleagues have investigated the parameters of left ventricular (LV) function during conventional continuous flow ECLS support and ECG‐synchronized pulsatile flow ECLS in cardiogenic shock . In their model, 10 female swine (body weight 45 kg) underwent ECLS implantation under general anesthesia and artificial ventilation.…”

Section: Pulsatile Versus Nonpulsatile Flow During Eclsmentioning

confidence: 99%

The Clinical Importance of Pulsatile Flow in Extracorporeal Life Support: The Penn State Health Approach

et al. 2016

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Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock

Cited by 34 publications

References 29 publications

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

Novel ECG-Synchronized Pulsatile ECLS System With Various Heart Rates and Cardiac Arrhythmias: An In Vitro Study

The Clinical Importance of Pulsatile Flow in Extracorporeal Life Support: The Penn State Health Approach

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