心源性休克中体外膜肺氧合与左心室辅助装置支持的闭环自动控制系统

Closed-Loop Automated Control System of Extracorporeal Membrane Oxygenation and Left Ventricular Assist Device Support in Cardiogenic Shock.

作者信息

Unoki Takashi, Uemura Kazunori, Yokota Shohei, Matsushita Hiroki, Kakuuchi Midori, Morita Hidetaka, Sato Kei, Yoshida Yuki, Sasaki Kazumasu, Kataoka Yasuyuki, Nishikawa Takuya, Fukumitsu Masafumi, Kawada Toru, Sunagawa Kenji, Alexander Joe, Saku Keita

机构信息

From the Department of Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.

出版信息

ASAIO J. 2025 Jun 1;71(6):461-471. doi: 10.1097/MAT.0000000000002359. Epub 2024 Dec 17.

DOI:10.1097/MAT.0000000000002359

PMID:39688218

Abstract

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) benefits patients with cardiogenic shock (CS) but can increase left ventricular afterload and exacerbate pulmonary edema. Adding a percutaneous left ventricular assist device (LVAD) to VA-ECMO can optimize the hemodynamics. Because managing VA-ECMO and LVAD simultaneously is complex and labor-intensive, we developed a closed-loop automated control system for VA-ECMO and LVAD. Based on the circulatory equilibrium framework, this system automatically adjusts VA-ECMO and LVAD flows and cardiovascular drug and fluid dosages to achieve target arterial pressure (AP, 70 mm Hg), left atrial pressure ( PLA , 14 mm Hg), and total systemic flow ( Ftotal , 120-140 ml/min/kg). In seven anesthetized dogs with CS, VA-ECMO significantly increased AP and PLA from 24 (23-27) to 71 (63-77) mm Hg and 20.1 (16.3-22.1) to 43.0 (25.7-51.4) mm Hg, respectively. Upon system activation, PLA was promptly reduced. At 60 min postactivation, the system-controlled AP to 69 (65-74) mm Hg, PLA to 12.5 (12.0-13.4) mm Hg, and Ftotal to 117 (114-132) ml/min/kg while adjusting VA-ECMO flow to 59 (12-60) ml/min/kg, LVAD flow to 68 (54-78) ml/min/kg, and cardiovascular drug and fluid dosages. This system automatically optimizes VA-ECMO and LVAD hemodynamics, making it an attractive tool for rescuing patients with CS.

摘要

静脉-动脉体外膜肺氧合（VA-ECMO）对心源性休克（CS）患者有益，但会增加左心室后负荷并加重肺水肿。在VA-ECMO基础上增加经皮左心室辅助装置（LVAD）可优化血流动力学。由于同时管理VA-ECMO和LVAD复杂且耗费人力，我们开发了一种用于VA-ECMO和LVAD的闭环自动控制系统。基于循环平衡框架，该系统自动调整VA-ECMO和LVAD的流量以及心血管药物和液体剂量，以实现目标动脉压（AP，70 mmHg）、左心房压（PLA，14 mmHg）和总全身血流量（Ftotal，120 - 140 ml/min/kg）。在七只麻醉的CS犬中，VA-ECMO使AP和PLA分别从24（23 - 27）mmHg显著增加到71（63 - 77）mmHg和从20.1（16.3 - 22.1）mmHg增加到43.0（25.7 - 51.4）mmHg。系统启动后，PLA迅速降低。在激活后60分钟，系统将AP控制在69（65 - 74）mmHg，PLA控制在12.5（12.0 - 13.4）mmHg，Ftotal控制在117（114 - 132）ml/min/kg，同时将VA-ECMO流量调整为59（12 - 60）ml/min/kg，LVAD流量调整为68（54 - 78）ml/min/kg，并调整心血管药物和液体剂量。该系统自动优化VA-ECMO和LVAD的血流动力学，使其成为抢救CS患者的有吸引力的工具。