Critical Care volume 28,
Article number: 330, Published: 08 October 2024
Background
Veno-venous extracorporeal membrane oxygenation (VV ECMO)
has become standard of care in patients with the most severe forms of acute
respiratory distress syndrome. However, hemolysis and bleeding are one of the
most frequent side effects, affecting mortality. Despite the widespread use of
VV ECMO, current protocols lack detailed, in-vivo data-based recommendations
for safe ECMO pump operating conditions. This study aims to comprehensively
analyze the impact of VV ECMO pump operating conditions on hemolysis by
combining in-silico modeling and clinical data analysis.
Methods
We combined data from 580 patients treated with VV ECMO in
conjunction with numerical predictions of hemolysis using computational fluid
dynamics and reduced order modeling of the Rotaflow (Getinge) and DP3 (Xenios)
pumps. Blood trauma parameters across 94,779 pump operating points were
associated with numerical predictions of shear induced hemolysis.
Results
Minimal hemolysis was observed at low pump pressures and low
circuit resistance across all flow rates, whereas high pump pressures and
circuit resistance consistently precipitated substantial hemolysis,
irrespective of flow rate. However, the lower the flow rate, the more
pronounced the influence of circuit resistance on hemolysis became. Numerical
models validated against clinical data demonstrated a strong association
(Spearman’s r = 0.8) between simulated and
observed hemolysis, irrespective of the pump type.
Conclusions
Integrating in-silico predictions with clinical data
provided a novel approach in understanding and potentially reducing blood
trauma in VV ECMO. This study further demonstrated that a key factor in
lowering side effects of ECMO support is the maintenance of low circuit
resistance, including oxygenators with the lowest possible resistance, the
shortest feasible circuit tubing, and cannulae with an optimal diameter.
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