Noritsugu Naito1, Takashi Nishimura2, Kei Iizuka3, Yutaka Fujii3, Yoshiaki Takewa3, Akihide Umeki4, Masahiko Ando4, Minoru Ono4, Eisuke Tatsumi3. 1. Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Electronic address: nori.naito@gmail.com. 2. Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan. 3. Department of Artificial Organs, National Cerebral and Cardiovascular Center, Research Institute, Osaka, Japan. 4. Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Abstract
BACKGROUND: Femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to maintain blood flow in patients with cardiogenic shock. However, retrograde blood flow increases left ventricular (LV) afterload during femoral VA-ECMO. Additional support by means of an intraaortic balloon pump (IABP) alleviates LV afterload but is associated with significant adverse events. We previously developed a system for rotational speed modulation in synchrony with the native cardiac cycle, for use with implantable continuous-flow LV assist devices. Here, we aimed to evaluate whether our novel rotation speed modulation system can improve coronary artery flow and reduce LV during femoral VA-ECMO. METHODS: VA-ECMO was installed by means of right atrial drainage and distal abdominal aortic perfusion in six adult goats. Cardiogenic shock was induced with β-adrenergic antagonist infusion. An IABP was placed in the descending aorta. LV stroke work, LV end-systolic pressure, and coronary arterial flow were evaluated. Data were collected under five conditions (modes): baseline, circuit-clamp (cardiogenic shock), continuous mode (constant rotational speed), counterpulse mode (increasing rotational speed during diastole), and continuous mode with IABP support. RESULTS: LV stroke work and LV end-systolic pressure tended to be lower in the counterpulse mode, indicating decreased LV work load and afterload in this mode. Furthermore, coronary arterial flow tended to be higher in the counterpulse mode. CONCLUSIONS: Our system enabled an increase in coronary arterial flow and a decrease in LV work load and afterload during VA-ECMO. The system offers the effects of VA-ECMO and an IABP in a single device.
BACKGROUND: Femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to maintain blood flow in patients with cardiogenic shock. However, retrograde blood flow increases left ventricular (LV) afterload during femoral VA-ECMO. Additional support by means of an intraaortic balloon pump (IABP) alleviates LV afterload but is associated with significant adverse events. We previously developed a system for rotational speed modulation in synchrony with the native cardiac cycle, for use with implantable continuous-flow LV assist devices. Here, we aimed to evaluate whether our novel rotation speed modulation system can improve coronary artery flow and reduce LV during femoral VA-ECMO. METHODS:VA-ECMO was installed by means of right atrial drainage and distal abdominal aortic perfusion in six adult goats. Cardiogenic shock was induced with β-adrenergic antagonist infusion. An IABP was placed in the descending aorta. LV stroke work, LV end-systolic pressure, and coronary arterial flow were evaluated. Data were collected under five conditions (modes): baseline, circuit-clamp (cardiogenic shock), continuous mode (constant rotational speed), counterpulse mode (increasing rotational speed during diastole), and continuous mode with IABP support. RESULTS:LV stroke work and LV end-systolic pressure tended to be lower in the counterpulse mode, indicating decreased LV work load and afterload in this mode. Furthermore, coronary arterial flow tended to be higher in the counterpulse mode. CONCLUSIONS: Our system enabled an increase in coronary arterial flow and a decrease in LV work load and afterload during VA-ECMO. The system offers the effects of VA-ECMO and an IABP in a single device.
Authors: Silver Heinsar; Sacha Rozencwajg; Jacky Suen; Gianluigi Li Bassi; Maximilian Malfertheiner; Leen Vercaemst; Lars Mikael Broman; Matthieu Schmidt; Alain Combes; Indrek Rätsep; John F Fraser; Jonathan E Millar Journal: Intensive Care Med Exp Date: 2020-05-25
Authors: Silver Heinsar; Jae-Seung Jung; Sebastiano Maria Colombo; Sacha Rozencwajg; Karin Wildi; Kei Sato; Carmen Ainola; Xiaomeng Wang; Gabriella Abbate; Noriko Sato; Wayne Bruce Dyer; Samantha Annie Livingstone; Leticia Pretti Pimenta; Nicole Bartnikowski; Mahe Jeannine Patricia Bouquet; Margaret Passmore; Bruno Vidal; Chiara Palmieri; Janice D Reid; Haris M Haqqani; Daniel McGuire; Emily Susan Wilson; Indrek Rätsep; Roberto Lorusso; Jacky Y Suen; Gianluigi Li Bassi; John F Fraser Journal: Sci Rep Date: 2021-10-14 Impact factor: 4.379