Modeling the effect of patient size on cerebral perfusion during veno-arterial extracorporeal membrane oxygenation

被引:2
作者
Feiger, Bradley [1 ]
Jensen, Christopher W. [1 ,2 ]
Bryner, Benjamin S. [2 ]
Segars, William P. [3 ]
Randles, Amanda [1 ,4 ]
机构
[1] Duke Univ, Sch Med, Dept Bioengn, Durham, NC USA
[2] Duke Univ, Dept Surg, Div Cardiovasc & Thorac Surg, Durham, NC USA
[3] Duke Med, Sch Med, Dept Radiol, Chicago, IL USA
[4] Duke Univ, Sch Med, Dept Bioengn, Box 90281, Durham, NC 27708 USA
来源
PERFUSION-UK | 2024年 / 39卷 / 07期
基金
美国国家卫生研究院;
关键词
extracorporeal membrane oxygenation; cerebral perfusion; mixing zone location; 1D simulations; NEAR-INFRARED SPECTROSCOPY; COMPUTATIONAL FLUID-DYNAMICS; NEUROLOGIC COMPLICATIONS; WAVE-PROPAGATION; ADULT PATIENTS; LIFE-SUPPORT; FLOW; AUTOREGULATION; SURVIVAL; OUTCOMES;
D O I
10.1177/02676591231187962
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction A well-known complication of veno-arterial extracorporeal membrane oxygenation (VA ECMO) is differential hypoxia, in which poorly-oxygenated blood ejected from the left ventricle mixes with and displaces well-oxygenated blood from the circuit, thereby causing cerebral hypoxia and ischemia. We sought to characterize the impact of patient size and anatomy on cerebral perfusion under a range of different VA ECMO flow conditions. Methods We use one-dimensional (1D) flow simulations to investigate mixing zone location and cerebral perfusion across 10 different levels of VA ECMO support in eight semi-idealized patient geometries, for a total of 80 scenarios. Measured outcomes included mixing zone location and cerebral blood flow (CBF). Results Depending on patient anatomy, we found that a VA ECMO support ranging between 67-97% of a patient's ideal cardiac output was needed to perfuse the brain. In some cases, VA ECMO flows exceeding 90% of the patient's ideal cardiac output are needed for adequate cerebral perfusion. Conclusions Individual patient anatomy markedly affects mixing zone location and cerebral perfusion in VA ECMO. Future fluid simulations of VA ECMO physiology should incorporate varied patient sizes and geometries in order to best provide insights toward reducing neurologic injury and improved outcomes in this patient population.
引用
收藏
页码:1295 / 1303
页数:9
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