Mathematical modelling of oxygenation under veno-venous ECMO configuration using either a femoral or a bicaval drainage

Abstract

Abstract Background The bicaval drainage under veno-venous extracorporeal membrane oxygenation (VV ECMO) was compared in present experimental study to the inferior caval drainage in terms of systemic oxygenation. Method Two mathematical models were built to simulate the inferior vena cava-to-right atrium (IVC → RA) route and the bicaval drainage-to-right atrium return (IVC + SVC → RA) route using the following parameters: cardiac output (Q C), IVC flow/Q C ratio, venous oxygen saturation, extracorporeal pump flow (Q EC), and pulmonary shunt (PULM-Shunt) to obtain pulmonary artery oxygen saturation (SPAO2) and systemic blood oxygen saturation (SaO2). Results With the IVC → RA route, SPAO2 and SaO2 increased linearly with Q EC/Q C until the threshold of the IVC flow/Q C ratio, beyond which the increase in SPAO2 reached a plateau. With the IVC + SVC → RA route, SPAO2 and SaO2 increased linearly with Q EC/Q C until 100% with Q EC/Q C = 1. The difference in required Q EC/Q C between the two routes was all the higher as SaO2 target or PULM-Shunt were high, and occurred all the earlier as PULM-Shunt were high. The required Q EC between the two routes could differ from 1.0 L/min (Q C = 5 L/min) to 1.5 L/min (Q C = 8 L/min) for SaO2 target = 90%. Corresponding differences of Q EC for SaO2 target = 94% were 4.7 L/min and 7.9 L/min, respectively. Conclusion Bicaval drainage under ECMO via the IVC + SVC → RA route gave a superior systemic oxygenation performance when both Q EC/Q C and pulmonary shunt were high. The VV-V ECMO configuration (IVC + SVC → RA route) might be an attractive rescue strategy in case of refractory hypoxaemia under VV ECMO.

Keywords

• Bicaval drainage
• Oxygenation determinants
• Oxygenation performance
• Pulmonary shunt
• Rescue therapy
• Structural recirculation