Synchronized Cardiac Support with Veno-Pulmonary Extracorporeal Membrane Oxygenation in a Simulation Mannequin

Area of Science:

• Cardiovascular physiology
• Biomedical engineering
• Critical care medicine

Background:

• Continuous flow extracorporeal membrane oxygenation (ECMO) may cause pulmonary edema and biotrauma.
• Electrocardiogram (ECG)-synchronized pulsatile flow is hypothesized to mitigate these adverse effects.

Purpose of the Study:

• To evaluate the hemodynamic effects of ECG-synchronized pulsatile flow using the iCOR device in a simulated veno-pulmonary (V-P) ECMO configuration.
• To assess the impact of pulsatile flow on pulmonary artery pressure (PAP) and right ventricular afterload under varying hemodynamic conditions.

Main Methods:

• Development of a benchtop mannequin simulating V-P ECMO with direct pulmonary artery blood return.
• Assessment of hemodynamic parameters using the iCOR device under three distinct clinical severity models with varying cardiac output, pulmonary vascular resistance (PVR), and heart rate.
• Comparison of pulsatile flow (ECMO with iCOR) against standard continuous flow ECMO across different flow rates and iCOR settings.

Main Results:

• Pulsatile flow via iCOR effectively increased pulse pressure and reduced diastolic PAP in low-resistance models.
• The benefits of pulsatile flow were attenuated as pulmonary vascular resistance (PVR) increased.
• Optimal pulse timing and strength were identified, with greatest hemodynamic benefits observed under low to moderate resistance conditions.

Conclusions:

• ECG-synchronized pulsatile flow modulated PAP in a resistance-dependent manner.
• Pulsatile flow demonstrated potential to enhance hemodynamics and reduce right ventricular afterload in low-resistance scenarios.
• Individualized ECMO and iCOR strategies tailored to specific pulmonary hemodynamics are necessary.