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Prisco AR, Aguado-Sierra J, Butakoff C, Vazquez M, Houzeaux G, Eguzkitza B, Bartos JA, Yannopoulos D, Raveendran G, Holm M, Iles T, Mahr C, Iaizzo PA. Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO. J Cardiovasc Transl Res 2022; 15:217-226. [PMID: 33624260 PMCID: PMC7901681 DOI: 10.1007/s12265-021-10110-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/15/2021] [Indexed: 12/23/2022]
Abstract
Venous-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. Illustration of the impact of north-south syndrome on organ-specific oxygen delivery. Patients on VA-ECMO have two sources of blood flow, one from the VA-ECMO circuit and one from the residual cardiac function. When there is no residual cardiac function, all organs are perfused with oxygenated blood. As myocardial recovery progresses, blood supply from the two sources will begin to mix resulting in non-homogeneous mixing and differential oxygenation based upon the anatomical site of branching vessels.
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Affiliation(s)
- Anthony R Prisco
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Jazmin Aguado-Sierra
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | | | - Mariano Vazquez
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | - Beatriz Eguzkitza
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | - Jason A Bartos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Demetris Yannopoulos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Ganesh Raveendran
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Mikayle Holm
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota Medical School, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Tinen Iles
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota Medical School, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Paul A Iaizzo
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota Medical School, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
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