A Computational Fluid Dynamics Study of the Extracorporeal Membrane Oxygenation-Failing Heart Circulation.
A Computational Fluid Dynamics Study of the Extracorporeal Membrane Oxygenation-Failing Heart Circulation.
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体外膜氧合衰竭心脏循环的计算流体动力学研究。
DOI：
10.1097/mat.0000000000001221
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发表时间：
2021-03-01
期刊：
影响因子：
--
通讯作者：
Keller SP
中科院分区：
文献类型：
--
作者：
Nezami FR;Khodaee F;Edelman ER;Keller SP
体外膜氧合（ECMO）越来越多地用于提供经皮机械循环支持，尽管对它与衰竭心脏的复杂相互作用及其对血流动力学和灌注的影响还不完全了解。使用主动脉及其主要分支的理想化几何形状和终止于髂动脉的外周插入的返回插管，进行计算流体动力学模拟以（1）量化灌注作为相对ECMO流量的函数，以及（2）描述由来自心脏的顺行流量和逆行ECMO流量的碰撞产生的分水岭区域。为了模拟不同程度的心力衰竭，在总流量的100%、90%、75%和50%下评估作为全身灌注分数的ECMO流量，剩余流量由心脏提供，根据患者衍生的流量波形计算。动态边界条件生成与三元素集总参数模型，以准确地模拟远端灌注。在严重衰竭（ECMO提供90%或更多的血流）中，分水岭区域位于主动脉弓中，在流向内脏器官的血流中观察到最小的脉动。心脏血流的适度增加将分水岭区域推进到胸主动脉，弓部灌注完全由心脏提供。
Extracorporeal membrane oxygenation (ECMO) is increasingly deployed to provide percutaneous mechanical circulatory support despite incomplete understanding of its complex interactions with the failing heart and its effects on hemodynamics and perfusion. Using an idealized geometry of the aorta and its major branches and a peripherally inserted return cannula terminating in the iliac artery, computational fluid dynamic simulations were performed to (1) quantify perfusion as function of relative ECMO flow and (2) describe the watershed region produced by the collision of antegrade flow from the heart and retrograde ECMO flow. To simulate varying degrees of cardiac failure, ECMO flow as a fraction of systemic perfusion was evaluated at 100%, 90%, 75%, and 50% of total flow with the remainder supplied by the heart calculated from a patient-derived flow waveform. Dynamic boundary conditions were generated with a three-element lumped parameter model to accurately simulate distal perfusion. In profound failure (ECMO providing 90% or more of flow), the watershed region was positioned in the aortic arch with minimal pulsatility observed in the flow to the visceral organs. Modest increases in cardiac flow advanced the watershed region into the thoracic aorta with arch perfusion entirely supplied by the heart.