A mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation support

Alberto Zanella, Domenico Salerno, Vittorio Scaravilli, Marco Giani, Luigi Castagna, Federico Magni, Eleonora Carlesso, Paolo Cadringher, Michela Bombino, Giacomo Grasselli, Nicolò Patroniti, Antonio Maria Pesenti

Research output: Contribution to journalArticle

Abstract

Purpose To develop a mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation (vv-ECMO). Material and methods Total oxygen consumption, cardiac output, blood flow, recirculation, intrapulmonary shunt, hemoglobin, natural lung, and membrane lung oxygen fractions were chosen as inputs. Content, partial pressure, and hemoglobin saturation of oxygen in arterial, venous, pulmonary, and extracorporeal blood were outputs. To assess accuracy and predictive power of the model, we retrospectively analyzed data of 25 vv-ECMO patients. We compiled 2 software (with numerical, 2D and 3D graphical outputs) to study the impact of each variable on oxygenation. Results The model showed high accuracy and predictive power. Raising blood flow and oxygen fraction to the membrane lung or reducing total oxygen consumption improves arterial and venous oxygenation, especially in severe cases; raising oxygen fraction to the natural lung improves oxygenation only in milder cases; raising hemoglobin always improves oxygenation, especially in the venous district; recirculation fraction severely impairs oxygenation. In severely ill patients, increasing cardiac output worsens arterial oxygenation but enhances venous oxygenation. Oxygen saturation of ECMO inlet is critical to evaluate the appropriateness of oxygen delivery. Conclusions The model with the software can be a useful teaching tool and a valuable decision-making aid for the management of hypoxic patients supported by vv-ECMO.

Original languageEnglish
Pages (from-to)178-186
Number of pages9
JournalJournal of Critical Care
Volume36
DOIs
Publication statusPublished - Dec 1 2016

Keywords

  • Blood circulation
  • Cardiac output
  • Extracorporeal circulation
  • Extracorporeal membrane oxygenation
  • Oxygen consumption
  • Theoretical models

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Zanella, A., Salerno, D., Scaravilli, V., Giani, M., Castagna, L., Magni, F., Carlesso, E., Cadringher, P., Bombino, M., Grasselli, G., Patroniti, N., & Pesenti, A. M. (2016). A mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation support. Journal of Critical Care, 36, 178-186. https://doi.org/10.1016/j.jcrc.2016.07.008