Analysis of left ventricular unloading by double lumen arterial cannula during ECMO assessed by mathematical modeling

Abstract

Extracorporeal membrane oxygenation is increasingly used for the therapy of the cardiogenic shock. However, it has been repeatedly shown that increased afterload associated with extracorporeal membrane oxygenation significantly deteriorates left ventricular performance. A number of approaches suggested how to deal with left ventricular unloading. Each of these methods requires extra interventions, which increase invasiveness of the method and thus does not correspond with current trends in the mini-invasive performance. Therefore, the development of a mini-invasive method of left heart decompression is a significant issue in extracorporeal membrane oxygenation therapy. The study presents an alternative mini-invasive method for the left ventricular unloading during extracorporeal membrane oxygenation. The draft of double lumen arterial cannula for left ventricular unloading during extracorporeal membrane oxygenation was created in AutoCAD software. The Modelica modeling language was used for modeling and simulations. The initial parameter values were derived from measurements on a female swine. Our simulation results indicate that drainage lumen of the presented double lumen arterial cannula for veno-arterial extracorporeal membrane oxygenation is capable of withdrawing 0.374 L/min during extracorporeal blood flow 1 L/min, 0.441 L/min during 2 L/min, 0.481 L/min during 3 L/min, 0.532 L/min during 4 L/min, 0.560 L/min during 5L/min. The double lumen arterial cannula presents an alternative and perspective solution. It is less invasive than the currently used methods for the left ventricle decompression during veno-arterial extracorporeal membrane oxygenation. The double lumen arterial cannula is capable of achieving left ventricle decompression and blood return while requiring only one single puncture.