Steady Flow Left Ventricle Unloading Is Superior to Pulsatile Pressure Augmentation Venting During Venoarterial Extracorporeal Membrane Oxygenation Support.

Autor:	Goffer EM; From the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts., Lamberti KK; From the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts., Spognardi AM; CBSET, Inc., Lexington, Massachusetts., Edelman ER; From the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts.; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Keller SP; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2024 Nov 01; Vol. 70 (11), pp. 929-937. Date of Electronic Publication: 2024 Apr 08.
DOI:	10.1097/MAT.0000000000002208
Abstrakt:	Venoarterial extracorporeal membrane oxygenation (VA-ECMO) shunts venous blood to the systemic arterial circulation to provide end-organ perfusion while increasing afterload that may impede left ventricle (LV) ejection and impair cardiac recovery. To maintain flow across the aortic valve and reduce risk of lethal clot formation, secondary mechanical circulatory support (MCS) devices are increasingly used despite limited understanding of their effects on cardiac function. This study sought to quantify the effects of VA-ECMO and combined with either intraaortic balloon pump (IABP) or percutaneous ventricular assist device (pVAD) on LV physiologic state and perfusion metrics in a porcine model of acute cardiogenic shock. Shock was induced through serial left anterior descending artery microbead embolization followed by initiation of VA-ECMO support and then placement of either IABP or pVAD. Hemodynamic measurements, LV pressure-volume loops, and carotid artery blood flow were evaluated before and after institution of combined MCS. The IABP decreased LV end-diastolic pressure by a peak of 15% while slightly increasing LV stroke work compared with decreases of more than 60% and 50% with the pVAD, respectively. The pVAD also demonstrated increased coronary perfusion and systemic pressure gradients in comparison to the IABP. Combined support with VA-ECMO and pVAD improves cardiovascular state in comparison to IABP. (Copyright © ASAIO 2024.)
Databáze:	MEDLINE
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