Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 162-8480, Japan.
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Sci Rep. 2024 Jun 19;14(1):14125. doi: 10.1038/s41598-024-64721-1.
Mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella, have been widely used for patients with cardiogenic shock (CS). However, hemodynamics with each device and combination therapy is not thoroughly understood. We aimed to elucidate the hemodynamics with MCS using a pulsatile flow model. Hemodynamics with Impella CP, VA-ECMO, and a combination of Impella CP and VA-ECMO were assessed based on the pressure and flow under support with each device and the pressure-volume loop of the ventricle model. The Impella CP device with CS status resulted in an increase in aortic pressure and a decrease in end-diastolic volume and end-diastolic pressure (EDP). VA-ECMO support resulted in increased afterload, leading to a significant increase in aortic pressure with an increase in end-systolic volume and EDP and decreasing venous reservoir pressure. The combination of Impella CP and VA-ECMO led to left ventricular unloading, regardless of increase in afterload. Hemodynamic support with Impella and VA-ECMO should be a promising combination for patients with severe CS.
机械循环支持（MCS）装置，包括静脉-动脉体外膜肺氧合（VA-ECMO）和 Impella，已广泛用于治疗心源性休克（CS）患者。然而，每种设备和联合治疗的血流动力学并不完全清楚。我们旨在使用脉动流模型阐明 MCS 的血流动力学。根据每种设备的支持压力和流量以及心室模型的压力-容积环，评估 Impella CP、VA-ECMO 和 Impella CP 和 VA-ECMO 联合治疗的血流动力学。CS 状态下的 Impella CP 装置导致主动脉压升高，舒张末期容积和舒张末期压（EDP）降低。VA-ECMO 支持导致后负荷增加，导致主动脉压显著升高，同时收缩末期容积和 EDP 增加，静脉储压器压力降低。Impella CP 和 VA-ECMO 的联合使用导致左心室卸载，而不增加后负荷。Impella 和 VA-ECMO 的血流动力学支持可能是严重 CS 患者的一种有前途的联合治疗方法。
