Watershed phenomena during extracorporeal life support and their clinical impact: a systematic in vitro investigation.
Johannes GehronMaximilian SchusterFlorian RindlerMarkus BongertAndreas BöningGabriele KrombachMartin FiebichPhilippe Grieshabernull nullPublished in: ESC heart failure (2020)
Our systematic fluid-mechanical analysis confirms the clinical assumption that despite restoring haemodynamic stability, extracorporeal support generates an inhomogeneous distribution of oxygenated blood with an inadequate supply to end organs and increased left-ventricular afterload with absent ventricular unloading. End-organ supply may be monitored by near-infrared spectroscopy, but an obviously non-controllable watershed emphasizes the need for additional measures: pre-pulmonary oxygenation with a veno-arterial-venous ECLS configuration can allow a transpulmonary passage of oxygenated blood, providing improved end-organ supply.
Keyphrases
- left ventricular
- heart failure
- pulmonary hypertension
- extracorporeal membrane oxygenation
- acute myocardial infarction
- hypertrophic cardiomyopathy
- mitral valve
- cardiac resynchronization therapy
- coronary artery disease
- water quality
- blood flow
- atrial fibrillation
- aortic stenosis
- percutaneous coronary intervention
- data analysis