Individualized real-time clinical decision support to monitor cardiac loading during venoarterial ECMO

Table 1 Comparison of clinical and simulated hemodynamic data before (two left columns) and the first day after initiation of VA-ECMO (two right columns)

		Before ECMO		+ECMO only	On ECMO first day
		Patient	Simulation	Simulation	Patient	Simulation
Heart rate	/min	137	137	137	133	133
Mean arterial pressure	mmHg	85	85	106	98	98
Right ventricular systolic pressure	mmHg	49	49	46	NA	47
Central venous pressure	mmHg	10	10	9	8	9
Left Ventricular end‐diastolic volume	mL	84.6	84.7	93.3	101.1	93.7
Left ventricular end‐diastolic pressure	mmHg	NA	19	23	NA	23
Ejection fraction	%	27.6	27.8	19.5	30.9	23.4
Tricuspid regurgitation velocity	cm/s	311	315	310	NA	NA
ECMO flow	L/min	0	0	2.1	2.1	2.1

The middle column +ECMO only shows effects of solely increasing peripheral ECMO flow from 0 to 2.1 L/min. Simulated data concerning the first day on VA ECMO are adjusted according to clinical data (HR identical, SVR and PVR decreased proportionally to achieve identical MAP, TR removed). Simulation supports the experimental findings of increased LV loading with VA-ECMO. The larger LV and EF in the patient on the first day of VA ECMO is compatible with fluid loading and partial recovery of LV function in addition to the effects of VA-ECMO as supported by clinical data
HR heart rate, SVR systemic vascular resistance, PVR pulmonary vascular resistance, MAP mean arterial pressure, TR tricuspid regurgitation, LV left ventricle and EF ejection fraction, NA data are not available

ISSN: 1479-5876