TY - JOUR
T1 - Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO
AU - Prisco, Anthony R.
AU - Aguado-Sierra, Jazmin
AU - Butakoff, Constantine
AU - Vazquez, Mariano
AU - Houzeaux, Guillaume
AU - Eguzkitza, Beatriz
AU - Bartos, Jason A.
AU - Yannopoulos, Demetris
AU - Raveendran, Ganesh
AU - Holm, Mikayle
AU - Iles, Tinen
AU - Mahr, Claudius
AU - Iaizzo, Paul A.
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2022/4
Y1 - 2022/4
N2 - Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for acute cardiogenic shock in patients who also have acute lung injury predisposes development of a serious complication called “north-south syndrome” (NSS) which causes cerebral hypoxia. NSS is poorly characterized and hemodynamic studies have focused on cerebral perfusion ignoring the heart. We hypothesized in NSS the heart would be more likely to receive hypoxemic blood than the brain due to the proximity of the coronary arteries to the aortic annulus. To test this, we conducted a computational fluid dynamics simulation of blood flow in a human supported by VA-ECMO. Simulations quantified the fraction of blood at each aortic branching vessel originating from residual native cardiac output versus VA-ECMO. As residual cardiac function was increased, simulations demonstrated myocardial hypoxia would develop prior to cerebral hypoxia. These results illustrate the conditions where NSS will develop and the relative cardiac function that will lead to organ-specific hypoxia. Graphical Abstract: [Figure not available: see fulltext.]
AB - Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for acute cardiogenic shock in patients who also have acute lung injury predisposes development of a serious complication called “north-south syndrome” (NSS) which causes cerebral hypoxia. NSS is poorly characterized and hemodynamic studies have focused on cerebral perfusion ignoring the heart. We hypothesized in NSS the heart would be more likely to receive hypoxemic blood than the brain due to the proximity of the coronary arteries to the aortic annulus. To test this, we conducted a computational fluid dynamics simulation of blood flow in a human supported by VA-ECMO. Simulations quantified the fraction of blood at each aortic branching vessel originating from residual native cardiac output versus VA-ECMO. As residual cardiac function was increased, simulations demonstrated myocardial hypoxia would develop prior to cerebral hypoxia. These results illustrate the conditions where NSS will develop and the relative cardiac function that will lead to organ-specific hypoxia. Graphical Abstract: [Figure not available: see fulltext.]
KW - Acute respiratory distress syndrome
KW - Computational fluid dynamics
KW - North-south syndrome
KW - VA-ECMO
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U2 - 10.1007/s12265-021-10110-2
DO - 10.1007/s12265-021-10110-2
M3 - Article
C2 - 33624260
AN - SCOPUS:85101668660
SN - 1937-5387
VL - 15
SP - 217
EP - 226
JO - Journal of cardiovascular translational research
JF - Journal of cardiovascular translational research
IS - 2
ER -