The following is a summary of “Blood trauma in veno-venous extracorporeal membrane oxygenation: low pump pressures and low circuit resistance matter,” published in the October 2024 issue of Critical Care by Blum et al.
Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a standard treatment for severe respiratory distress, but its effectiveness is limited by hemolysis and bleeding complications.
Researchers conducted a retrospective study to comprehensively analyze the relationship between VV ECMO pump operating conditions and hemolysis using in-silico modeling and clinical data.
They examined 580 VV ECMO patients with numerical hemolysis predictions using computational fluid dynamics and reduced order modeling of the Rotaflow (Getinge) and DP3 (Xenios) pumps. Blood trauma parameters from 94,779 pump operating points were correlated with numerical shear-induced hemolysis predictions.
The results showed minimal hemolysis at low pump pressures and low circuit resistance across all flow rates. Conversely, high pump pressures and circuit resistance consistently led to substantial hemolysis, regardless of flow rate while the circuit resistance’s impact on hemolysis became more pronounced at lower flow rates. Numerical models, validated against clinical data, demonstrated a strong association (Spearman’s r = 0.8) between simulated and observed hemolysis, irrespective of the pump type.
They concluded that reducing blood trauma in VV ECMO was achieved by maintaining low circuit resistance, utilizing oxygenators with minimal resistance, shorter circuit tubing, and optimally sized cannulae.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05121-9