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

Abstract

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.