Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO

• DOI: 10.1007/s12265-021-10110-2
• Publication Date: 2021-02-23T19:28:05Z
• Authors: Anthony R. Prisco; Jazmin Aguado-Sierra; Constantine Butakoff; Mariano Vazquez; Guillaume Houzeaux; Beatriz Eguzkitza; Jason A. Bartos; Demetris Yannopoulos; Ganesh Raveendran; Mikayle Holm; Tinen Iles; Claudius Mahr; Paul A. Iaizzo
• Keywords: Sang -- Circulació; Acute respiratory distress syndrome; :Enginyeria biomèdica [Àrees temàtiques de la UPC]; 0206 medical engineering; Shock, Cardiogenic; Venous arteries; Arteries; 02 engineering and technology; Computer simulation; Computational fluid dynamics; Àrees temàtiques de la UPC::Enginyeria biomèdica; Blood -- Circulation; North-south syndrome; 3. Good health; Extracorporeal Membrane Oxygenation; Simulació per ordinador; VA-ECMO; Humans; Original Article; Respiratory Insufficiency; Lung

AbstractVenous-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for acute cardiogenic shock in patients who also have acute lung injury predisposes development of a serious complication called “north-south syndrome” (NSS) which causes cerebral hypoxia. NSS is poorly characterized and hemodynamic studies have focused on cerebral perfusion ignoring the heart. We hypothesized in NSS the heart would be more likely to receive hypoxemic blood than the brain due to the proximity of the coronary arteries to the aortic annulus. To test this, we conducted a computational fluid dynamics simulation of blood flow in a human supported by VA-ECMO. Simulations quantified the fraction of blood at each aortic branching vessel originating from residual native cardiac output versus VA-ECMO. As residual cardiac function was increased, simulations demonstrated myocardial hypoxia would develop prior to cerebral hypoxia. These results illustrate the conditions where NSS will develop and the relative cardiac function that will lead to organ-specific hypoxia. Graphical Abstract