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Review
. 2023 Sep 12:14:1231016.
doi: 10.3389/fphys.2023.1231016. eCollection 2023.

Interactions between extracorporeal support and the cardiopulmonary system

Kaspar F Bachmann  1   2 , David Berger  1 , Per Werner Moller  3
Affiliations
Review

Interactions between extracorporeal support and the cardiopulmonary system

Kaspar F Bachmann et al. Front Physiol. .

Abstract

This review describes the intricate physiological interactions involved in the application of extracorporeal therapy, with specific focus on cardiopulmonary relationships. Extracorporeal therapy significantly influences cardiovascular and pulmonary physiology, highlighting the necessity for clinicians to understand these interactions for improved patient care. Veno-arterial extracorporeal membrane oxygenation (veno-arterial ECMO) unloads the right ventricle and increases left ventricular (LV) afterload, potentially exacerbating LV failure and pulmonary edema. Veno-venous (VV) ECMO presents different challenges, where optimal device and ventilator settings remain unknown. Influences on right heart function and native gas exchange as well as end-expiratory lung volumes are important concepts that should be incorporated into daily practice. Future studies should not be limited to large clinical trials focused on mortality but rather address physiological questions to advance the understanding of extracorporeal therapies. This includes exploring optimal device and ventilator settings in VV ECMO, standardizing cardiopulmonary function monitoring strategies, and developing better strategies for device management throughout their use. In this regard, small human or animal studies and computational physiological modeling may contribute valuable insights into optimizing the management of extracorporeal therapies.

Keywords: ECMO; cardiac output; gas exchange; membrane lung; pulmonary physiology; venous return.

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Conflict of interest statement

The Department of Intensive Care Medicine, Inselspital Bern has, or has had in the past, research contracts with Abionic SA, AVA AG, CSEM SA, Cube Dx GmbH, Cyto Sorbents Europe GmbH, Edwards Lifesciences LLC, GE Healthcare, ImaCor Inc., MedImmune LLC, Orion Corporation, and Phagenesis Ltd. and research and development/consulting contracts with Edwards Lifesciences LLC, Nestec SA, and Wyss Zurich. The money was paid into a departmental fund; no author received any personal financial gain. The Department of Intensive Care Medicine received unrestricted educational grants from the following organizations for organizing a quarterly postgraduate educational symposium, the Berner Forum for Intensive Care (until 2015): Abbott AG, Anandic Medical Systems, Astellas, AstraZeneca, Bard Medica SA, Baxter, B | Braun, CSL Behring, Covidien, Fresenius Kabi, GSK, Lilly, Maquet, MSD, Novartis, Nycomed, Orion Pharma, Pfizer, and Pierre Fabre Pharma AG (formerly known as RobaPharm). The Department of Intensive Care Medicine has received unrestricted educational grants from the following organizations for organizing biannual postgraduate courses in the fields of critical care ultrasound, management of extracorporeal membrane oxygenation, and mechanical ventilation: Abbott AG, Anandic Medical Systems, Bard Medica SA., Bracco, Dräger Schweiz AG, Edwards Lifesciences AG, Fresenius Kabi (Schweiz) AG, Getinge Group Maquet AG, Hamilton Medical AG, Pierre Fabre Pharma AG (formerly known as RobaPharm), PanGas AG Healthcare, Pfizer AG, Orion Pharma, and Teleflex Medical GmbH.

Figures

FIGURE 1
FIGURE 1
Theoretical analysis of proposed interaction between CO2 removal, mechanical power, and RV power. (A) Relationship between total VCO2, VCO2 lung and VCO2 ECMO. An increase in the transfer from lung to VV ECMO reduces VCO2 lung in a linear relationship. (B) Mechanical power (MP) as a function of gas exchange transfer from the lung to the ECMO. While the mechanical power at the lung (MPLung) is a linear function of lung VCO2, the RV power (MPRV) may form a u-shaped curve. A potential optimal setting (red point) refers to the minimum of the power sums and indicates the optimal points of gas exchange transfer.
See this image and copyright information in PMC

References

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