De Lazzari Beatrice, Capoccia Massimo, Badagliacca Roberto, Maybauer Marc O, De Lazzari Claudio
Human Movement and Sport Sciences, University of Rome "Foro Italico", 00135 Rome, Italy.
Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", 00135 Rome, Italy.
Bioengineering (Basel). 2025 May 17;12(5):540. doi: 10.3390/bioengineering12050540.
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) for the management of refractory cardiogenic shock (CS) has been widely used in recent years. Increased left ventricular (LV) afterload induced by retrograde flow remains a limiting factor, which is particularly evident during peripheral VA ECMO support. The concomitant use of the intra-aortic balloon pump (IABP) is an established strategy to achieve LV unloading during VA ECMO support. Nevertheless, there remains controversy about the combined use of IABP during central or peripheral VA ECMO in terms of beneficial effects and outcome. We developed a simulation setting to study left ventricular unloading with IABP during peripheral and central VA ECMO using CARDIOSIM©, an established software simulator of the cardiovascular system. The aim was to quantitatively evaluate potential differences between the two VA ECMO configurations and ascertain the true beneficial effects compared to VA ECMO alone. The combined use of central VA ECMO and IABP decreased left ventricular end systolic volume and left ventricular end diastolic volume by 5-10%; right ventricular end systolic volume and right ventricular end diastolic volume by 10-20%; left atrial end systolic volume and left atrial end diastolic volume by 5-10%. Up to 25% reduction in mean left atrial pressure, up to 15% reduction in pulmonary capillary wedge pressure and up to 25% reduction in mean pulmonary arterial pressure was observed. From an energetic point of view, left ventricular external work decreased by 10-15% whilst up to 40%vreduction in right ventricular external work was observed. The findings make central VA ECMO plus IABP the most appropriate combination for left and right ventricle unloading.
近年来，静脉 - 动脉体外膜肺氧合（VA ECMO）在难治性心源性休克（CS）的治疗中得到了广泛应用。逆行血流导致的左心室（LV）后负荷增加仍然是一个限制因素，在外周VA ECMO支持期间尤为明显。在VA ECMO支持期间，同时使用主动脉内球囊泵（IABP）是实现左心室卸载的既定策略。然而，关于在中心或外周VA ECMO期间联合使用IABP的有益效果和结果仍存在争议。我们开发了一种模拟设置，使用已建立的心血管系统软件模拟器CARDIOSIM©来研究在外周和中心VA ECMO期间使用IABP进行左心室卸载。目的是定量评估两种VA ECMO配置之间的潜在差异，并确定与单独使用VA ECMO相比的真正有益效果。中心VA ECMO和IABP联合使用可使左心室收缩末期容积和左心室舒张末期容积减少5 - 10%；右心室收缩末期容积和右心室舒张末期容积减少10 - 20%；左心房收缩末期容积和左心房舒张末期容积减少5 - 10%。观察到平均左心房压力降低高达25%，肺毛细血管楔压降低高达15%，平均肺动脉压力降低高达25%。从能量角度来看，左心室外部功降低了10 - 15%，而右心室外部功降低高达40%。这些发现使中心VA ECMO加IABP成为左、右心室卸载的最合适组合。
