Key result
In simulated profound cardiac failure (ECMO providing ≥90% of flow), the watershed region was positioned in the aortic arch with minimal pulsatility observed in visceral organ flow.
Why the study?
ECMO is increasingly deployed despite incomplete understanding of its complex interactions with the failing heart and its effects on hemodynamics and perfusion.
How does varying the ratio of ECMO flow to cardiac flow affect systemic perfusion and the location of the hemodynamic watershed region in a computational model of a failing heart?
How does varying the ratio of ECMO flow to cardiac flow affect systemic perfusion and the location of the hemodynamic watershed region in a computational model of a failing heart?
Computational fluid dynamics demonstrate that the hemodynamic watershed region during peripheral ECMO shifts from the aortic arch to the thoracic aorta as native cardiac output increases.
CFD insights into ECMO perfusion patterns warrant clinical caution; leaves open patient-specific validation.
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.
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Nezami et al. (2020) studied ECMO-failing heart circulation. Varying degrees of ECMO flow (100%, 90%, 75%, and 50% of total flow) was evaluated on Perfusion and watershed region position. In simulated profound cardiac failure (ECMO providing ≥90% of flow), the watershed region was positioned in the aortic arch with minimal pulsatility observed in visceral organ flow.
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