Multiscale modeling of blood flow to assess neurological complications in patients supported by venoarterial extracorporeal membrane oxygenation

Purpose This study aimed to assess a new approach combining venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) in adults, while monitoring CRRT circuit pressures. Methods The inlet and outlet of the CRRT circuit were connected to preoxygenator port and postoxygenator port, respectively. Then, complications and CRRT circuit pressures were evaluated. Results 7 patients underwent combined VA-ECMO and CRRT; 16 filters were used. CRRT blood flow ranged from 150 to 200 mL/min; the CRRT to ECMO blood flow ratio was <0.1. The CRRT pressures at treatment initiation were normal. No complications were reported. Conclusions This approach combining VA-ECMO and CRRT in adults did not compromise the accuracy of pressure monitoring systems for CRRT circuit function, and caused no complications. Hence, it may be a feasible method for performing combined VA-ECMO and CRRT in adults.

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Determining the impacts of venoarterial extracorporeal membrane oxygenation on cerebral oxygenation using a one-dimensional blood flow simulator

Journal of Biomechanics ◽

10.1016/j.jbiomech.2020.109707 ◽

2020 ◽

Vol 104 ◽

pp. 109707 ◽

Cited By ~ 1

Author(s):

Bradley Feiger ◽

Ajar Kochar ◽

John Gounley ◽

Desiree Bonadonna ◽

Mani Daneshmand ◽

...

Keyword(s):

Blood Flow ◽

Extracorporeal Membrane Oxygenation ◽

Cerebral Oxygenation ◽

One Dimensional ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Flow Simulator

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Regional Tissue Oximetry Reflects Changes in Arterial Flow in Porcine Chronic Heart Failure Treated With Venoarterial Extracorporeal Membrane Oxygenation

Physiological Research ◽

10.33549/physiolres.933532 ◽

2016 ◽

pp. S621-S631 ◽

Cited By ~ 6

Author(s):

P. HÁLA ◽

M. MLČEK ◽

P. OŠŤÁDAL ◽

D. JANÁK ◽

M. POPKOVÁ ◽

...

Keyword(s):

Heart Failure ◽

Blood Flow ◽

Chronic Heart Failure ◽

Extracorporeal Membrane Oxygenation ◽

Tissue Oxygenation ◽

Arterial Flow ◽

Arterial Blood Flow ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Va Ecmo

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in treatment of decompensated heart failure. Our aim was to investigate its effects on regional perfusion and tissue oxygenation with respect to extracorporeal blood flow (EBF). In five swine, decompensated low-output chronic heart failure was induced by long-term rapid ventricular pacing. Subsequently, VA ECMO was introduced and left ventricular (LV) volume, aortic blood pressure, regional arterial flow and tissue oxygenation were continuously recorded at different levels of EBF. With increasing EBF from minimal to 5 l/min, mean arterial pressure increased from 47±22 to 84±12 mm Hg (P<0.001) and arterial blood flow increased in carotid artery from 211±72 to 479±58 ml/min (P<0.01) and in subclavian artery from 103±49 to 296±54 ml/min (P<0.001). Corresponding brain and brachial tissue oxygenation increased promptly from 57±6 to 74±3 % and from 37±6 to 77±6 %, respectively (both P<0.01). Presented results confirm that VA ECMO is a capable form of heart support. Regional arterial flow and tissue oxygenation suggest that partial circulatory support may be sufficient to supply brain and peripheral tissue by oxygen.

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Novel Utilization of the Bridge during Weaning off Venoarterial ECMO: The Hoffman Clamp Method

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000276 ◽

2016 ◽

Vol 11 (3) ◽

pp. 229-231 ◽

Cited By ~ 3

Author(s):

Sarah E. Holgren ◽

Ryan T. Frede ◽

Jennifer P. Crumley ◽

Sonali S. Patel ◽

Elizabeth A. Moore ◽

...

Keyword(s):

Blood Flow ◽

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Standard Practice ◽

Clamp Technique ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Decrease Blood Flow

Standard practice for weaning patients off venoarterial extracorporeal membrane oxygenation (ECMO) occurs by decreasing pump flows until idle flow is achieved. This method is limited in its use because it is difficult to assess a patient's true potential to successfully come off ECMO when supported by idle flow. We have developed a weaning technique that uses a Hoffman clamp on the bridge to decrease blood flow to the patient beyond idle flow. This method was used to wean eight patients from venoarterial ECMO. No patients weaned with this technique required emergent reinstitution of ECMO. The Hoffman clamp technique has allowed us to safely wean patients off ECMO support while maintaining integrity of the circuit.

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Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management

Critical Care Research and Practice ◽

10.1155/2018/3237810 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Syed Omar Kazmi ◽

Sanjeev Sivakumar ◽

Dimitrios Karakitsos ◽

Abdulrahman Alharthy ◽

Christos Lazaridis

Keyword(s):

Blood Flow ◽

Extracorporeal Membrane Oxygenation ◽

Cerebral Autoregulation ◽

Flow Characteristics ◽

Neurological Complications ◽

Ecmo Circuit ◽

Membrane Oxygenation ◽

Life Saving ◽

The World ◽

Cerebral Physiology

Extracorporeal membrane oxygenation (ECMO) is a life-saving technique that is widely being used in centers throughout the world. However, there is a paucity of literature surrounding the mechanisms affecting cerebral physiology while on ECMO. Studies have shown alterations in cerebral blood flow characteristics and subsequently autoregulation. Furthermore, the mechanical aspects of the ECMO circuit itself may affect cerebral circulation. The nature of these physiological/pathophysiological changes can lead to profound neurological complications. This review aims at describing the changes to normal cerebral autoregulation during ECMO, illustrating the various neuromonitoring tools available to assess markers of cerebral autoregulation, and finally discussing potential neurological complications that are associated with ECMO.

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