From the Department of Anesthesiology, Columbia University, New York, New York.
ASAIO J. 2018 Jul/Aug;64(4):497-501. doi: 10.1097/MAT.0000000000000660.
The use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) to support patients with acute heart failure has been associated with ventricular distension and pulmonary edema, the mechanism of which is not fully understood. This study examined the impact of VA ECMO on left ventricular (LV) Starling curves to elaborate a framework for anticipating and treating LV distension. A previously developed and validated model of the cardiovascular system was used to generate pressure-volume (PV) loops and Starling curves while holding mean arterial pressure (mABP) constant at a range of values either by adjusting systemic resistance or by adding VA ECMO support. It was found that under all conditions of similar mAPB, the Starling curve was unchanged; therefore, the degree of LV distension is obligated by the mAPB (irrespective of whether controlled pharmacologically with or without ECMO support and independent of heart rate), LV contractility, and target stroke volume. The Starling relationship provides a conceptual framework for understanding the risk and treatment of LV distension during VA ECMO support.
使用静脉-动脉（VA）体外膜肺氧合（ECMO）来支持急性心力衰竭患者与心室扩张和肺水肿有关，其机制尚未完全阐明。本研究检查了 VA ECMO 对左心室（LV）Starling 曲线的影响，以阐述预测和治疗 LV 扩张的框架。使用先前开发和验证的心血管系统模型来生成压力-容积（PV）环和 Starling 曲线，同时将平均动脉压（mABP）保持在一系列值，方法是调整全身阻力或添加 VA ECMO 支持。结果发现，在所有具有相似 mAPB 的条件下，Starling 曲线均未改变；因此，LV 扩张的程度取决于 mAPB（无论是否通过药理学控制或有无 ECMO 支持，以及与心率无关）、LV 收缩性和目标每搏量。Starling 关系提供了一个概念框架，用于理解 VA ECMO 支持期间 LV 扩张的风险和治疗。
