Mimotělní podpora cirkulace v léčbě srdeční zástavy a kardiogenního šoku

Abstract

Cardiogenic shock and cardiac arrest still have a poor prognosis with a high mortality rate. Extracorporeal membrane oxygenation is increasingly used for the treatment of cardiogenic shock; it is an indispensable therapy for the acute treatment of patients with cardiogenic shock and cardiac arrest. However, extracorporeal membrane oxygenation has a signicant risk of complications. An important pitfall of extracorporeal membrane oxygenation, which can highly impair patient outcome, is inappropriate left ventricular unloading. A number of approaches have been suggested for dealing with left ventricular unloading during extracor-poreal membrane oxygenation. Nevertheless, each of the currently existing methods requires further intervention; the nowadays methods can be the reason of additional complications such as bleeding, infection, and prolong recovery time of extracorporeal membrane oxygena-tion treated patients. The left ventricular decompression, during extracorporeal membrane oxygenation therapy, is associated with signicant improvement of the left ventricular func-tion. Therefore, the development of a mini-invasive method of left heart decompression is a signicant issue in extracorporeal membrane oxygenation therapy. The purpose of this doctoral thesis is to develop an alternative method of left ventricular unloading or left ven-tricular overload reduction, which has the potential for reducing the invasiveness of left ventricular unloading during veno-arterial extracorporeal membrane oxygenation therapy, based on modeling, simulation, and experiments. Data of hemodynamic and cardiac perfor-mance parameters were obtained from porcine models of cardiogenic shock; some of these data were used for numerical modeling and numerical simulations in the Modelica modeling language (Modelica Association) in the Dymola (Dassault Systemes) modeling environment and using the components from Physiolibrary 2.3.1. The statistical analysis of obtained data from a porcine model of cardiogenic shock was conducted by using GraphPad Prism 5.0 software (GraphPad, USA) and R 3.5.3 software (The R Foundation, Vienna, Austria). The drafts of the double lumen arterial cannula for extracorporeal membrane oxygenation was created in AutoCAD software. An experimental study in a porcine model of cardiogenic shock conrmed the undesirable negative eects of veno-arterial extracorporeal membrane oxygenation on left ventricular performance parameters in a ow-dependent manner. The simulation study indicated that the double lumen arterial cannula cannula for veno-arterial extracorporeal membrane oxygenation with 10 Fr drainage lumen achieves reduction of left ventricular loading, and it takes into account human physiological features. With decreasing venous cannula size, the percentage of left ventricular loading during veno-arterial extracorpo-real membrane oxygenation is decreased without an increase of double lumen arterial cannula size. An experimental study in a porcine model of cardiogenic shock conrms that with the application of double lumen arterial cannula instead of the standard arterial cannula dur-ing veno-arterial extracorporeal membrane oxygenation, there is a signicant improvement in selected hemodynamic parameters. Among other things, biomedical engineering involves advising manufacturers of medical devices on promising improvements based on clinical expe-rience, the application, and implementation of medical technologies to optimize the delivery of medical care. These aspects of biomedical engineering are realized in this doctoral thesis.

Cardiogenic shock and cardiac arrest still have a poor prognosis with a high mortality rate. Extracorporeal membrane oxygenation is increasingly used for the treatment of cardiogenic shock; it is an indispensable therapy for the acute treatment of patients with cardiogenic shock and cardiac arrest. However, extracorporeal membrane oxygenation has a signicant risk of complications. An important pitfall of extracorporeal membrane oxygenation, which can highly impair patient outcome, is inappropriate left ventricular unloading. A number of approaches have been suggested for dealing with left ventricular unloading during extracorporeal membrane oxygenation. Nevertheless, each of the currently existing methods requires further intervention; the nowadays methods can be the reason of additional complications such as bleeding, infection, and prolong recovery time of extracorporeal membrane oxygenation treated patients. The left ventricular decompression, during extracorporeal membrane oxygenation therapy, is associated with signicant improvement of the left ventricular function. Therefore, the development of a mini-invasive method of left heart decompression is a signicant issue in extracorporeal membrane oxygenation therapy. The purpose of this doctoral thesis is to develop an alternative method of left ventricular unloading or left ventricular overload reduction, which has the potential for reducing the invasiveness of left ventricular unloading during veno-arterial extracorporeal membrane oxygenation therapy, based on modeling, simulation, and experiments. Data of hemodynamic and cardiac performance parameters were obtained from porcine models of cardiogenic shock; some of these data were used for numerical modeling and numerical simulations in the Modelica modeling language (Modelica Association) in the Dymola (Dassault Systemes) modeling environment and using the components from Physiolibrary 2.3.1. The statistical analysis of obtained data from a porcine model of cardiogenic shock was conducted by using GraphPad Prism 5.0 software (GraphPad, USA) and R 3.5.3 software (The R Foundation, Vienna, Austria). The drafts of the double lumen arterial cannula for extracorporeal membrane oxygenation was created in AutoCAD software. An experimental study in a porcine model of cardiogenic shock conrmed the undesirable negative eects of veno-arterial extracorporeal membrane oxygenation on left ventricular performance parameters in a ow-dependent manner. The simulation study indicated that the double lumen arterial cannula cannula for veno-arterial extracorporeal membrane oxygenation with 10 Fr drainage lumen achieves reduction of left ventricular loading, and it takes into account human physiological features. With decreasing venous cannula size, the percentage of left ventricular loading during veno-arterial extracorporeal membrane oxygenation is decreased without an increase of double lumen arterial cannula size. An experimental study in a porcine model of cardiogenic shock conrms that with the application of double lumen arterial cannula instead of the standard arterial cannula during veno-arterial extracorporeal membrane oxygenation, there is a signicant improvement in selected hemodynamic parameters. Among other things, biomedical engineering involves advising manufacturers of medical devices on promising improvements based on clinical experience, the application, and implementation of medical technologies to optimize the delivery of medical care. These aspects of biomedical engineering are realized in this doctoral thesis.