ID:157 FC-D07-2 Automated Gas Exchange Control for Physiological Stability in Veno-Venous Extracorporeal Membrane Oxygenation: A Systematic Review

Background: Conventional manual titration of sweep gas in Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is often hindered by human response lag, leading to unpredictable pCO2 variability. While Cerebral Blood Flow (CBF) dysregulation in ECMO is multifactorial, fluctuations in pCO2 represent one of the most dynamic and acutely modifiable triggers of cerebral vasoreactivity. Automated Physiological Closed-Loop Control (PCLC) systems aim to eliminate these fluctuations to achieve precise metabolic homeostasis. Objective: To systematically evaluate the efficacy of automated gas control systems in mitigating physiological variability and preserving cerebral autoregulatory integrity compared to standard manual management in VV-ECMO. Methods: Following PRISMA guidelines, a search of 150 records (2016–2026) was conducted across PubMed, Scopus, IEEE Xplore, and Cochrane. Eighteen studies–comprising human trials, animal models, and high-fidelity simulations–were selected for qualitative synthesis based on their focus on automated feedback loops and clinician-led requirements. Results: Automated systems demonstrated a 20% reduction in pCO2 and pH variance compared to manual adjustments. The data indicates that automated titration maintains pCO2 within a significantly tighter therapeutic window, thereby minimizing the risk of sudden cerebral vasoconstriction or vasodilation. The synthesis identified three primary operational pillars: (1) Hemodynamic Autonomy, (2) Metabolic Precision, and (3) Safety Guardrails. Conclusion: Automation in VV-ECMO provides a critical “metabolic shield” by continuously stabilizing blood gas parameters. By significantly reducing pCO2 fluctuations, these systems mitigate a major trigger of CBF dysregulation while simultaneously reducing the cognitive burden on clinical teams in high-acuity surgical environments.