Veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be vital to support patients in severe or rapidly progressing cardiogenic shock. In cases of left ventricular distension, left ventricular decompression during VA ECMO may be a crucial factor influencing the patient outcome. Application of a double lumen arterial cannula for a left ventricular unloading is an alternative, straightforward method for left ventricular decompression during extracorporeal membrane oxygenation in a veno-arterial configuration.
The purpose of this paper is to use a mathematical model of the human adult cardiovascular system to analyse the left ventricular function of a patient in cardiogenic shock supported by veno-arterial extracorporeal membrane oxygenation with and without the application of left-ventricular unloading using a novel double-lumen arterial cannula.
A lumped model of cardiovascular system hydraulics has been coupled with models of non-pulsatile VA ECMO, a standard venous cannula and a drainage lumen of a double lumen arterial cannula. Cardiogenic shock has been induced by decreasing left ventricular contractility to 10% of baseline normal value.
The simulation results indicate that applying double lumen arterial cannula during VA ECMO is associated with reduction of left ventricular end-systolic volume, end-diastolic volume, end-systolic pressure and end-diastolic pressure.
A double lumen arterial cannula is a viable alternative less invasive method for LV decompression during VA ECMO. However, to allow for satisfactory ECMO flow, the cannula design has to be revisited.
An online simulator is runnable at virtualrat.org/models/ecmo-dlac-model-demonstration.
Online model repository
The model is available at github.com/filip-jezek/physiolibrary.models.