静脉体外膜氧合过程中动脉插管和引流插管的流动能力:模拟模型。

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Perfusion-Uk Pub Date : 2025-04-01 Epub Date: 2024-05-23 DOI:10.1177/02676591241256502
Avishka Wickramarachchi, Aidan J C Burrell, Patrick R Joyce, Rinaldo Bellomo, Jaishankar Raman, Shaun D Gregory, Andrew F Stephens
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引用次数: 0

摘要

背景:大插管会增加静脉体外膜肺氧合(VA ECMO)过程中与插管相关的并发症。相反,人们对小插管提供充分支持的能力却知之甚少。因此,我们的目的是在模拟患者的不同疾病状态下,评估一系列插管尺寸和 VA ECMO 流速:方法: 在连接到模拟循环回路的 VA ECMO 电路中测试了 13 至 21 Fr 的动脉插管和 21 至 25 Fr 的引流插管,模拟患者患有严重的左心室衰竭。通过改变全身和肺血管阻力(分别为 SVR 和 PVR)来模拟全身和肺动脉高压、生理正常和低血压。针对 SVR、PVR 和 VA ECMO 流速的所有组合,对所有插管组合进行了评估:结果:15 Fr 动脉插管与 21 Fr 引流插管组合可提供大于 4 L/min 的总流量和 81.1 mmHg 的平均动脉压。SVR 的变化导致所有测量参数发生明显变化,而 PVR 的变化影响甚微。较大的引流插管只有在与较大的动脉插管结合使用时才能提高最大回路流速:结论:较小的插管和较低的流速可以在各种疾病状态下为模拟病人提供足够的支持。我们发现动脉插管尺寸和 SVR 是决定任何特定 VA ECMO 循环流量输送能力的关键因素。总之,我们的研究结果对必须使用较大插管和高流量才能获得充分 ECMO 支持的观点提出了质疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Flow capabilities of arterial and drainage cannulae during venoarterial extracorporeal membrane oxygenation: A simulation model.

BackgroundLarge cannulae can increase cannula-related complications during venoarterial extracorporeal membrane oxygenation (VA ECMO). Conversely, the ability for small cannulae to provide adequate support is poorly understood. Therefore, we aimed to evaluate a range of cannula sizes and VA ECMO flow rates in a simulated patient under various disease states.MethodsArterial cannulae sizes between 13 and 21 Fr and drainage cannula sizes between 21 and 25 Fr were tested in a VA ECMO circuit connected to a mock circulation loop simulating a patient with severe left ventricular failure. Systemic and pulmonary hypertension, physiologically normal, and hypotension were simulated by varying systemic and pulmonary vascular resistances (SVR and PVR, respectively). All cannula combinations were evaluated against all combinations of SVR, PVR, and VA ECMO flow rates.ResultsA 15 Fr arterial cannula combined with a 21 Fr drainage cannula could provide >4 L/min of total flow and a mean arterial pressure of 81.1 mmHg. Changes in SVR produced marked changes to all measured parameters, while changes to PVR had minimal effect. Larger drainage cannulae only increased maximum circuit flow rates when combined with larger arterial cannulae.ConclusionSmaller cannulae and lower flow rates could sufficiently support the simulated patient under various disease states. We found arterial cannula size and SVR to be key factors in determining the flow-delivering capabilities for any given VA ECMO circuit. Overall, our results challenge the notion that larger cannulae and high flows must be used to achieve adequate ECMO support.

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来源期刊
Perfusion-Uk
Perfusion-Uk 医学-外周血管病
CiteScore
3.00
自引率
8.30%
发文量
203
审稿时长
6-12 weeks
期刊介绍: Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
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