Watershed phenomena during extracorporeal life support and their clinical impact: a systematic in vitro investigation

体外 医学 心源性休克 体外循环 心脏病学 生命维持 升主动脉 内科学 主动脉 心输出量 体外膜肺氧合 血流动力学 血流 麻醉 心肌梗塞 重症监护医学
作者
Johannes Gehron,Maximilian Schuster,Florian Rindler,Markus Bongert,Andreas Böning,Gabriele A. Krombach,Martin Fiebich,Philippe Grieshaber
出处
期刊:Esc Heart Failure [Wiley]
卷期号:7 (4): 1850-1861 被引量:13
标识
DOI:10.1002/ehf2.12751
摘要

Abstract Aims Extracorporeal life support (ECLS) during acute cardiac failure restores haemodynamic stability and provides life‐saving cardiopulmonary support. Unfortunately, all common cannulation strategies and remaining pulmonary blood flow increase left‐ventricular afterload and may favour pulmonary congestion. The resulting disturbed pulmonary gas exchange and a residual left‐ventricular action can contribute to an inhomogeneous distribution of oxygenated blood into end organs. These complex flow interactions between native and artificial circulation cannot be investigated at the bedside: only an in vitro simulation can reveal the underlying activities. Using an in vitro mock circulation loop, we systematically investigated the impact of heart failure, extracorporeal support, and cannulation routes on the formation of flow phenomena and flow distribution in the arterial tree. Methods and results The mock circulation loop consisted of two flexible life‐sized vascular models (aorta and vena cava) driven by two paracorporeal assist devices, resistance elements, and compliance reservoirs to mimic the circulatory system. Several large‐bore antegrade and retrograde access ports allowed connection to an ECLS system for extracorporeal support. With four degrees of extracorporeal support—that for cardiac failure, early recovery, late recovery, and weaning—we investigated aortic blood flow velocity, blood flow, and mixing zones using colour‐coded Doppler ultrasound in the aorta and its corresponding branches. Full retrograde extracorporeal support (3–4 L/min) perfused major portions of the aorta but did not reach the supra‐aortic branches and ascending aorta, resulting in an area in the thoracic aorta demonstrating nearly stagnant blood flow velocities during cardiogenic shock and early recovery (0 ± 4 cm/s; −10 ± 15 cm/s, respectively) confined by two watersheds at the aortic isthmus and renal artery origin. Even increased ECLS flow was unable to shift the watershed towards the aortic arch. Antegrade support resulted in homogeneous flow distribution during all stages of cardiac failure but created a markedly negative flow vector in the ascending aorta during cardiogenic shock and early recovery with increased afterload. Conclusions Our systematic fluid‐mechanical analysis confirms the clinical assumption that despite restoring haemodynamic stability, extracorporeal support generates an inhomogeneous distribution of oxygenated blood with an inadequate supply to end organs and increased left‐ventricular afterload with absent ventricular unloading. End‐organ supply may be monitored by near‐infrared spectroscopy, but an obviously non‐controllable watershed emphasizes the need for additional measures: pre‐pulmonary oxygenation with a veno‐arterial‐venous ECLS configuration can allow a transpulmonary passage of oxygenated blood, providing improved end‐organ supply.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
YamDaamCaa应助Cedric采纳,获得30
刚刚
刚刚
Ava应助初雪平寒采纳,获得10
1秒前
yanlibiu完成签到,获得积分10
1秒前
HYHY发布了新的文献求助10
1秒前
1秒前
STOOd完成签到 ,获得积分10
1秒前
Yve发布了新的文献求助10
1秒前
2秒前
坦率晓霜完成签到,获得积分10
2秒前
2秒前
2秒前
2秒前
orixero应助妖哥采纳,获得10
3秒前
smj发布了新的文献求助10
3秒前
3秒前
传奇3应助合适的灵枫采纳,获得10
3秒前
4秒前
turbohero完成签到,获得积分10
4秒前
ZZ发布了新的文献求助10
4秒前
小星发布了新的文献求助10
5秒前
酷波er应助齐羽采纳,获得10
6秒前
肥呱子发布了新的文献求助10
6秒前
angel发布了新的文献求助10
7秒前
HY发布了新的文献求助10
7秒前
Charley发布了新的文献求助10
7秒前
7秒前
12138的9527完成签到,获得积分10
8秒前
8秒前
卜婉君发布了新的文献求助10
8秒前
Susan111应助酷炫的若剑采纳,获得10
8秒前
wjx关闭了wjx文献求助
8秒前
smj完成签到,获得积分10
8秒前
9秒前
李健应助unique采纳,获得10
9秒前
homer完成签到,获得积分10
10秒前
吃狗粮的猫完成签到 ,获得积分10
10秒前
10秒前
上官若男应助123456采纳,获得10
10秒前
10秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3974463
求助须知:如何正确求助?哪些是违规求助? 3518823
关于积分的说明 11196212
捐赠科研通 3255008
什么是DOI,文献DOI怎么找? 1797655
邀请新用户注册赠送积分活动 877052
科研通“疑难数据库(出版商)”最低求助积分说明 806130