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Introduction Peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) creates a retrograde flow along the aorta competing with the left ventricle (LV) in the so-called ‘mixing zone’ (MZ). Detecting it is essential to understand which of the LV or the ECMO flow perfuses the upper body –...

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Published in:Anaesthesia critical care & pain medicine 2022-06, Vol.41 (3)
Main Authors: Heinsar, Silver, Jung, Jae-Seung, Colombo, Sebastiano Maria, Rozencwajg, Sacha, Wildi, Karin, Sato, Kei, Ainola, Carmen, Wang, Xiaomeng, Abbate, Gabriella, Sato, Noriko, Dyer, Wayne Bruce, Livingstone, Samantha Annie, Pimenta, Leticia Pretti, Bartnikowski, Nicole, Bouquet, Mahe Jeannine Patricia, Passmore, Margaret, Vidal, Bruno, Palmieri, Chiara, Reid, Janice, Haqqani, Haris, Mcguire, Daniel, Wilson, Emily Susan, Rätsep, Indrek, Lorusso, Roberto, Suen, Jacky, Bassi, Gianluigi Li, Fraser, John
Format: Article
Language:English
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Life Sciences
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Summary:Introduction Peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) creates a retrograde flow along the aorta competing with the left ventricle (LV) in the so-called ‘mixing zone’ (MZ). Detecting it is essential to understand which of the LV or the ECMO flow perfuses the upper body – particularly the brain and the coronary arteries – in case of differential hypoxemia (DH). Methods We described a mock circulation loop (MCL) that enabled experimental research on DH. We recreated the three clinical situations relevant to clinicians: where the brain is either totally perfused by the ECMO or the LV or both. In a second step, we used this model to investigate two scenarios to diagnose DH: (i) pulse pressure and (ii) thermodilution via injection of cold saline in the ECMO circuit. Results The presented MCL was able to reproduce the three relevant mixing zones within the aortic arch, thus allowing to study DH. Pulse pressure was unable to detect location of the MZ. However, the thermodilution method was able to detect whether the brain was totally perfused by the ECMO or not. Conclusion We validated an in-vitro differential hypoxemia model of cardiogenic shock supported by VA ECMO. This MCL could be used as an alternative to animal studies for research scenarios.
ISSN:2352-5568
2352-5568
DOI:10.1038/s41598-021-00087-y