Closed-Loop Automated Control System of Extracorporeal Membrane Oxygenation and Left Ventricular Assist Device...

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) benefits patients with cardiogenic shock (CS) but can increase left ventricular afterload and exacerbate pulmonary edema. Adding a percutaneous left ventricular assist device (LVAD) to VA-ECMO can optimize the hemodynamics. Because managing VA-ECMO and LVAD simultaneously is complex and labor-intensive, we developed a closed-loop automated control system for VA-ECMO and LVAD. Based on the circulatory equilibrium framework, this system automatically adjusts VA-ECMO and LVAD flows and cardiovascular drug and fluid dosages to achieve target arterial pressure (AP, 70 mm Hg), left atrial pressure ( PLA , 14 mm Hg), and total systemic flow ( Ftotal , 120-140 ml/min/kg). In seven anesthetized dogs with CS, VA-ECMO significantly increased AP and PLA from 24 (23-27) to 71 (63-77) mm Hg and 20.1 (16.3-22.1) to 43.0 (25.7-51.4) mm Hg, respectively. Upon system activation, PLA was promptly reduced. At 60 min postactivation, the system-controlled AP to 69 (65-74) mm Hg, PLA to 12.5 (12.0-13.4) mm Hg, and Ftotal to 117 (114-132) ml/min/kg while adjusting VA-ECMO flow to 59 (12-60) ml/min/kg, LVAD flow to 68 (54-78) ml/min/kg, and cardiovascular drug and fluid dosages. This system automatically optimizes VA-ECMO and LVAD hemodynamics, making it an attractive tool for rescuing patients with CS.