Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become standard of care in patients with the most severe forms of acute respiratory distress syndrome. However, hemolysis and bleeding are one of the most frequent side effects, affecting mortality. Despite the widespread use of VV ECMO, current protocols lack detailed, in-vivo data-based recommendations for safe ECMO pump operating conditions. This study aims to comprehensively analyze the impact of VV ECMO pump operating conditions on hemolysis by combining in-silico modeling and clinical data analysis. We combined data from 580 patients treated with VV ECMO in conjunction with numerical predictions of hemolysis using computational fluid dynamics and reduced order modeling of the Rotaflow (Getinge) and DP3 (Xenios) pumps. Blood trauma parameters across 94,779 pump operating points were associated with numerical predictions of shear induced hemolysis. Minimal hemolysis was observed at low pump pressures and low circuit resistance across all flow rates, whereas high pump pressures and circuit resistance consistently precipitated substantial hemolysis, irrespective of flow rate. However, the lower the flow rate, the more pronounced the influence of circuit resistance on hemolysis became. 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. Integrating in-silico predictions with clinical data provided a novel approach in understanding and potentially reducing blood trauma in VV ECMO. This study further demonstrated that a key factor in lowering side effects of ECMO support is the maintenance of low circuit resistance, including oxygenators with the lowest possible resistance, the shortest feasible circuit tubing, and cannulae with an optimal diameter.

中文翻译：

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静脉-静脉体外膜肺氧合中的血液创伤：低泵压力和低电路电阻


静脉-静脉体外膜肺氧合 （VV ECMO） 已成为最严重急性呼吸窘迫综合征患者的标准治疗。然而，溶血和出血是最常见的副作用之一，会影响死亡率。尽管 VV ECMO 已广泛使用，但目前的方案缺乏详细的、基于体内数据的安全 ECMO 泵操作条件建议。本研究旨在通过结合计算机建模和临床数据分析，全面分析 VV ECMO 泵运行条件对溶血的影响。我们将 580 名接受 VV ECMO 治疗的患者的数据与使用计算流体动力学和 Rotaflow （Getinge） 和 DP3 （Xenios） 泵的降阶建模的溶血数值预测相结合。94,779 个泵操作点的血液创伤参数与剪切诱导溶血的数值预测相关。在所有流速下，在低泵压和低电路阻力下观察到轻微溶血，而高泵压和电路阻力始终会诱发大量溶血，而与流速无关。然而，流速越低，回路电阻对溶血的影响就越明显。根据临床数据验证的数值模型表明，模拟溶血和观察溶血之间存在很强的相关性 （Spearman's r = 0.8），与泵类型无关。将计算机模拟预测与临床数据相结合，为理解和潜在减少 VV ECMO 中的血液创伤提供了一种新方法。 这项研究进一步表明，降低 ECMO 支持副作用的一个关键因素是维持低电路电阻，包括具有尽可能低电阻的氧合器、最短的可行电路管和具有最佳直径的插管。