心血管系统与联合使用VA ECMO和IABP之间相互作用的建模和模拟:外围和中心配置的比较。

IF 3.8 3区 医学 Q2 ENGINEERING, BIOMEDICAL
Beatrice De Lazzari, Massimo Capoccia, Roberto Badagliacca, Marc O Maybauer, Claudio De Lazzari
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引用次数: 0

摘要

静脉-动脉体外膜氧合(VA ECMO)治疗难治性心源性休克(CS)近年来得到广泛应用。逆行血流引起的左心室后负荷增加仍然是一个限制因素,这在外周VA ECMO支持期间尤为明显。同时使用主动脉内球囊泵(IABP)是在VA ECMO支持期间实现左室卸载的既定策略。然而,关于在中央或外周VA ECMO期间联合使用IABP的有益效果和结果仍存在争议。我们利用CARDIOSIM©(一个已建立的心血管系统软件模拟器)开发了一个模拟设置来研究外周和中央心室ECMO期间IABP的左心室卸载。目的是定量评估两种VA ECMO配置之间的潜在差异,并确定与单独VA ECMO相比的真正有益效果。中心室ECMO联合IABP使左室收缩末容积和舒张末容积降低5-10%;右心室收缩末容积与右心室舒张末容积减少10-20%;左房收缩末容积和左房舒张末容积减小5-10%。平均左房压降低25%,肺毛细血管楔压降低15%,平均肺动脉压降低25%。从能量的角度来看,左心室外功减少了10-15%,而右心室外功减少了40%。结果表明,中央心室ECMO + IABP是左、右心室卸荷最合适的组合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Modelling and Simulation of the Interactions Between the Cardiovascular System and the Combined Use of VA ECMO and IABP: Comparison Between Peripheral and Central Configurations.

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) for the management of refractory cardiogenic shock (CS) has been widely used in recent years. Increased left ventricular (LV) afterload induced by retrograde flow remains a limiting factor, which is particularly evident during peripheral VA ECMO support. The concomitant use of the intra-aortic balloon pump (IABP) is an established strategy to achieve LV unloading during VA ECMO support. Nevertheless, there remains controversy about the combined use of IABP during central or peripheral VA ECMO in terms of beneficial effects and outcome. We developed a simulation setting to study left ventricular unloading with IABP during peripheral and central VA ECMO using CARDIOSIM©, an established software simulator of the cardiovascular system. The aim was to quantitatively evaluate potential differences between the two VA ECMO configurations and ascertain the true beneficial effects compared to VA ECMO alone. The combined use of central VA ECMO and IABP decreased left ventricular end systolic volume and left ventricular end diastolic volume by 5-10%; right ventricular end systolic volume and right ventricular end diastolic volume by 10-20%; left atrial end systolic volume and left atrial end diastolic volume by 5-10%. Up to 25% reduction in mean left atrial pressure, up to 15% reduction in pulmonary capillary wedge pressure and up to 25% reduction in mean pulmonary arterial pressure was observed. From an energetic point of view, left ventricular external work decreased by 10-15% whilst up to 40%vreduction in right ventricular external work was observed. The findings make central VA ECMO plus IABP the most appropriate combination for left and right ventricle unloading.

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来源期刊
Bioengineering
Bioengineering Chemical Engineering-Bioengineering
CiteScore
4.00
自引率
8.70%
发文量
661
期刊介绍: Aims Bioengineering (ISSN 2306-5354) provides an advanced forum for the science and technology of bioengineering. It publishes original research papers, comprehensive reviews, communications and case reports. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. All aspects of bioengineering are welcomed from theoretical concepts to education and applications. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. There are, in addition, four key features of this Journal: ● We are introducing a new concept in scientific and technical publications “The Translational Case Report in Bioengineering”. It is a descriptive explanatory analysis of a transformative or translational event. Understanding that the goal of bioengineering scholarship is to advance towards a transformative or clinical solution to an identified transformative/clinical need, the translational case report is used to explore causation in order to find underlying principles that may guide other similar transformative/translational undertakings. ● Manuscripts regarding research proposals and research ideas will be particularly welcomed. ● Electronic files and software regarding the full details of the calculation and experimental procedure, if unable to be published in a normal way, can be deposited as supplementary material. ● We also accept manuscripts communicating to a broader audience with regard to research projects financed with public funds. Scope ● Bionics and biological cybernetics: implantology; bio–abio interfaces ● Bioelectronics: wearable electronics; implantable electronics; “more than Moore” electronics; bioelectronics devices ● Bioprocess and biosystems engineering and applications: bioprocess design; biocatalysis; bioseparation and bioreactors; bioinformatics; bioenergy; etc. ● Biomolecular, cellular and tissue engineering and applications: tissue engineering; chromosome engineering; embryo engineering; cellular, molecular and synthetic biology; metabolic engineering; bio-nanotechnology; micro/nano technologies; genetic engineering; transgenic technology ● Biomedical engineering and applications: biomechatronics; biomedical electronics; biomechanics; biomaterials; biomimetics; biomedical diagnostics; biomedical therapy; biomedical devices; sensors and circuits; biomedical imaging and medical information systems; implants and regenerative medicine; neurotechnology; clinical engineering; rehabilitation engineering ● Biochemical engineering and applications: metabolic pathway engineering; modeling and simulation ● Translational bioengineering
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