Gu Kaiyun, Gao Sizhe, Zhang Zhe, Ji Bingyang, Chang Yu
National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310005, China.
Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Beijing 100037, China.
Bioengineering (Basel). 2022 Sep 20;9(10):487. doi: 10.3390/bioengineering9100487.
The pulsatile properties of arterial flow and pressure have been thought to be important. Nevertheless, a gap still exists in the hemodynamic effect of pulsatile flow in improving blood flow distribution of veno-arterial extracorporeal membrane oxygenation (VA ECMO) supported by the circulatory system. The finite-element models, consisting of the aorta, VA ECMO, and intra-aortic balloon pump (IABP) are proposed for fluid-structure interaction calculation of the mechanical response. Group A is cardiogenic shock with 1.5 L/min of cardiac output. Group B is cardiogenic shock with VA ECMO. Group C is added to IABP based on Group B. The sum of the blood flow of cardiac output and VA ECMO remains constant at 4.5 L/min in Group B and Group C. With the recovery of the left ventricular, the flow of VA ECMO declines, and the effective blood of IABP increases. IABP plays the function of balancing blood flow between left arteria femoralis and right arteria femoralis compared with VA ECMO only. The difference of the equivalent energy pressure (dEEP) is crossed at 2.0 L/min to 1.5 L/min of VA ECMO. PPI' (the revised pulse pressure index) with IABP is twice as much as without IABP. The intersection with two opposing blood generates the region of the aortic arch for the VA ECMO (Group B). In contrast to the VA ECMO, the blood intersection appears from the descending aorta to the renal artery with VA ECMO and IABP. The maximum time-averaged wall shear stress (TAWSS) of the renal artery is a significant difference with or not IABP (VA ECMO: 2.02 vs. 1.98 vs. 2.37 vs. 2.61 vs. 2.86 Pa; VA ECMO and IABP: 8.02 vs. 6.99 vs. 6.62 vs. 6.30 vs. 5.83 Pa). In conclusion, with the recovery of the left ventricle, the flow of VA ECMO declines and the effective blood of IABP increases. The difference between the equivalent energy pressure (EEP) and the surplus hemodynamic energy (SHE) indicates the loss of pulsation from the left ventricular to VA ECMO. 2.0 L/min to 1.5 L/min of VA ECMO showing a similar hemodynamic energy loss with the weak influence of IABP.
动脉血流和压力的搏动特性一直被认为很重要。然而，在循环系统支持的静脉-动脉体外膜肺氧合（VA ECMO）中，搏动血流对改善血流分布的血流动力学效应方面仍存在差距。提出了由主动脉、VA ECMO和主动脉内球囊泵（IABP）组成的有限元模型，用于机械响应的流固相互作用计算。A组为心源性休克，心输出量为1.5 L/min。B组为采用VA ECMO的心源性休克。C组在B组基础上增加IABP。B组和C组中心输出量与VA ECMO的血流总和保持恒定，为4.5 L/min。随着左心室的恢复，VA ECMO的血流量下降，IABP的有效血流量增加。与仅使用VA ECMO相比，IABP起到平衡左股动脉和右股动脉之间血流的作用。等效能量压力（dEEP）的差异在VA ECMO从2.0 L/min降至1.5 L/min时出现。使用IABP时的PPI'（修正脉压指数）是不使用IABP时的两倍。对于VA ECMO（B组），两个相反血流的交汇产生了主动脉弓区域。与VA ECMO相比，使用VA ECMO和IABP时，血流交汇从降主动脉延伸至肾动脉。肾动脉的最大时间平均壁面剪应力（TAWSS）在使用或不使用IABP时有显著差异（VA ECMO：2.02 vs. 1.98 vs. 2.37 vs. 2.61 vs. 2.86 Pa；VA ECMO和IABP：8.02 vs. 6.99 vs. 6.62 vs. 6.30 vs. 5.83 Pa）。总之，随着左心室的恢复，VA ECMO的血流量下降，IABP的有效血流量增加。等效能量压力（EEP）与剩余血流动力学能量（SHE）之间的差异表明从左心室到VA ECMO的搏动损失。VA ECMO从2.0 L/min降至1.5 L/min时显示出类似的血流动力学能量损失，且IABP的影响较弱。
