ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables. (April 2021)
- Record Type:
- Journal Article
- Title:
- ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables. (April 2021)
- Main Title:
- ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables
- Authors:
- De Lazzari, Beatrice
Iacovoni, Attilio
Mottaghy, Khosrow
Capoccia, Massimo
Badagliacca, Roberto
Vizza, Carmine Dario
De Lazzari, Claudio - Abstract:
- Abstract: Background and Objective: Simulation in cardiovascular medicine may help clinicians understand the important events occurring during mechanical ventilation and circulatory support. During the COVID-19 pandemic, a significant number of patients have required hospital admission to tertiary referral centres for concomitant mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Nevertheless, the management of ventilated patients on circulatory support can be quite challenging. Therefore, we sought to review the management of these patients based on the analysis of haemodynamic and energetic parameters using numerical simulations generated by a software package named CARDIOSIM©. Methods: New modules of the systemic circulation and ECMO were implemented in CARDIOSIM© platform. This is a modular software simulator of the cardiovascular system used in research, clinical and e-learning environment. The new structure of the developed modules is based on the concept of lumped (0-D) numerical modelling. Different ECMO configurations have been connected to the cardiovascular network to reproduce Veno-Arterial (VA) and Veno-Venous (VV) ECMO assistance. The advantages and limitations of different ECMO cannulation strategies have been considered. We have used literature data to validate the effects of a combined ventilation and ECMO support strategy. Results: The results have shown that our simulations reproduced the typical effects induced during mechanicalAbstract: Background and Objective: Simulation in cardiovascular medicine may help clinicians understand the important events occurring during mechanical ventilation and circulatory support. During the COVID-19 pandemic, a significant number of patients have required hospital admission to tertiary referral centres for concomitant mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Nevertheless, the management of ventilated patients on circulatory support can be quite challenging. Therefore, we sought to review the management of these patients based on the analysis of haemodynamic and energetic parameters using numerical simulations generated by a software package named CARDIOSIM©. Methods: New modules of the systemic circulation and ECMO were implemented in CARDIOSIM© platform. This is a modular software simulator of the cardiovascular system used in research, clinical and e-learning environment. The new structure of the developed modules is based on the concept of lumped (0-D) numerical modelling. Different ECMO configurations have been connected to the cardiovascular network to reproduce Veno-Arterial (VA) and Veno-Venous (VV) ECMO assistance. The advantages and limitations of different ECMO cannulation strategies have been considered. We have used literature data to validate the effects of a combined ventilation and ECMO support strategy. Results: The results have shown that our simulations reproduced the typical effects induced during mechanical ventilation and ECMO assistance. We focused our attention on ECMO with triple cannulation such as Veno-Ventricular-Arterial (VV-A) and Veno-Atrial-Arterial (VA-A) configurations to improve the hemodynamic and energetic conditions of a virtual patient. Simulations of VV-A and VA-A assistance with and without mechanical ventilation have generated specific effects on cardiac output, coupling of arterial and ventricular elastance for both ventricles, mean pulmonary pressure, external work and pressure volume area. Conclusion: The new modules of the systemic circulation and ECMO support allowed the study of the effects induced by concomitant mechanical ventilation and circulatory support. Based on our clinical experience during the COVID-19 pandemic, numerical simulations may help clinicians with data analysis and treatment optimisation of patients requiring both mechanical ventilation and circulatory support. … (more)
- Is Part Of:
- Computer methods and programs in biomedicine. Volume 202(2021)
- Journal:
- Computer methods and programs in biomedicine
- Issue:
- Volume 202(2021)
- Issue Display:
- Volume 202, Issue 2021 (2021)
- Year:
- 2021
- Volume:
- 202
- Issue:
- 2021
- Issue Sort Value:
- 2021-0202-2021-0000
- Page Start:
- Page End:
- Publication Date:
- 2021-04
- Subjects:
- ECMO -- Mechanical ventilation -- Pressure volume loop -- Lumped parameter model -- Software simulation -- Clinical environment -- Percutaneous left ventricular support -- Cannulation
Medicine -- Computer programs -- Periodicals
Biology -- Computer programs -- Periodicals
Computers -- Periodicals
Medicine -- Periodicals
Médecine -- Logiciels -- Périodiques
Biologie -- Logiciels -- Périodiques
Biology -- Computer programs
Medicine -- Computer programs
Periodicals
Electronic journals
610.28 - Journal URLs:
- http://www.sciencedirect.com/science/journal/01692607 ↗
http://www.elsevier.com/journals ↗ - DOI:
- 10.1016/j.cmpb.2021.106003 ↗
- Languages:
- English
- ISSNs:
- 0169-2607
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 3394.095000
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