Abstract
Veno-arterial extracoporeal membrane oxygenation (VA ECMO) is increasingly used for acute and refractory cardiogenic shock. Yet, in clinical practice, monitoring of cardiac loading conditions during VA ECMO can be cumbersome. To this end, we illustrate the validity and clinical applicability of a real-time cardiovascular computer simulation, which allows to integrate hemodynamics, cardiac dimensions and the corresponding degree of VA ECMO support and ventricular loading in individual patients over time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0760-1) contains supplementary material, which is available to authorized users.
Highlights
With great interest we read the recent publication by Ostadal et al Their experimental work underscores the clinical relevance to closely monitor left-ventricular (LV) loading conditions in cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation (VA ECMO) [1]
They report on significant negative influences on intrinsic cardiac output, left ventricular performance and stroke work as a result of increasing extracorporeal blood flow intended to maximally support the circulation in cardiogenic shock
The steep increase in arterial pressures and stroke work found experimentally while applying high flow is likely explained by an increase in systemic blood flow and by an increase in systemic vascular resistance (SVR) not commented by the authors
Summary
With great interest we read the recent publication by Ostadal et al Their experimental work underscores the clinical relevance to closely monitor left-ventricular (LV) loading conditions in cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation (VA ECMO) [1]. They report on significant negative influences on intrinsic cardiac output, left ventricular performance and stroke work as a result of increasing extracorporeal blood flow intended to maximally support the circulation in cardiogenic shock. In clinical practice, it can be challenging to provide adequate systemic perfusion, while addressing favourable LV loading conditions. The practical difficulties to optimally tailor VA ECMO may be improved by a bedside monitoring tool that allows instantaneous integration
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