A Computational Study of Perfusion During the ExtraCorporeal Membrane Oxygenation (ECMO)

A Computational Study of Perfusion During the ExtraCorporeal Membrane Oxygenation (ECMO)

Maria Vittoria Caruso (Bioengineering Unit, University Magna Grecia of Catanzaro, Catanzaro, Italy), Vera Gramigna (Bioengineering Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy), Attilio Renzulli (Cardiac Surgery Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy) and Gionata Fragomeni (Bioengineering Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy)
DOI: 10.4018/IJPHIM.2017010103
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Abstract

The extracorporeal membrane oxygenation (ECMO) is a common procedure of extracorporeal circulation (ECC) used in case of cardiopulmonary diseases. The major clinical complications are related to hemodynamic changes and to the mechanical shear stress. The aim of this study is to evaluate the effects of the modality of perfusion during ECMO, comparing the hemodynamic behavior generated by constant flow (normal modality) with the one obtained by pulsed perfusion induced by the intra-aortic balloon pump (IABP). To carry out the study, the computational fluid dynamic (CFD) approach was chosen, realizing a multi-scale model. The numerical results have highlighted that the IABP-induced pulsed perfusion increases both flow and pressure in the supraaortic vessels, even if the balloon makes the wall shear stress (WSS) pattern and the hemolysis index worse.
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Introduction

The extracorporeal membrane oxygenation (ECMO) is an extracorporeal procedure used for patients with cardiac or respiratory failures who do not react to conventional therapy (Harry Anderson, 1993; Paolini, 1994; Smith, 2001). Furthermore, it is also adopted as a post-operative circulation support after cardiac surgeries and as a prolonged but temporary support for weaning from the cardiopulmonary bypass (CPB) (Doll, 2004). The main clinical complications of the ECMO-treated patients are cerebral injuries and infarction, which can cause death (Doll, 2004; Risnes, 2005). Indeed, hemolysis, thromboembolic events and internal blending are the major complications related to the artificial organs (Goubergrits, 2006), and, above all, to the mechanical shear stress. To overcome them, anticoagulants must be administered even if they worsen the performance of the devices (Goubergrits, 2004).

As reported in (Ji, 2006), the pulsed perfusion during the extracorporeal circulation is healthier compared to the normal one, that is characterized by constant/linear flow. In 1977 the intra-aortic balloon pump (IABP) was proposed by (Bregman, 1977) as a useful device to provide pulsatile flow during CPB. The principal component of this mechanical support is a polyethylene balloon placed in the aorta after the left subclavian artery and before the iliac bifurcation, which inflates/deflates according to the cardiac cycle or setting the assistance level when there is no heart activity, such as during CPB or ECMO. Recently, some studies have highlighted different benefits of IABP-induced pulsatility during ECMO (Madershahian, 2009; Madershahian, 2011; Petroni, 2014; Yang, 2014).

Based to our knowledge, there is little information regarding the hemodynamic pattern in aorta and its incidence on clinical complications and, so, on illness development during normal/constant ECMO and IABP-induced pulsed ECMO. Therefore, a detailed analysis is necessary.

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