ECMO VA

Description

This validation scenario simulates the management of hemorrhagic shock followed by VA-ECMO support. The scenario begins with a class 2 hemorrhage. Hemorrhages are stopped, and VA-ECMO is initiated with an internal jugular vein inlet and carotid artery outlet.

Segment Validation

Segment 1

Initiate a 90 ml/min hemorrhage from the right arm. Initiate a 50 ml/min hemorrhage from the vena cava. Run for 590s.

Table 1. Data request validation results for Segment 1.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
HeartRate(1/min)	GreaterThan Baseline (72.0) [157]	106		46.60%	Increase
MeanArterialPressure(mmHg)	EqualTo 76 [157]	90.9	19.58%		~80% Normal
BloodVolume(mL)	EqualTo 4190	4.14e+03	-1.28%		Calculated
CardiacOutput(mL/min)	[3.64e+03,3.92e+03] [157]	4.39e+03	11.92%		~65-70% Normal
HeartStrokeVolume(mL)	LessThan Baseline (80.2) [157]	41.5		-48.21%	Decrease
HemoglobinContent(g)	EqualTo 630	616	-2.29%		Calculated
RespirationRate(1/min)	EqualTo Baseline (11.9) [157]	12.5	5.00%		No Change

Figure 1. Vitals monitor for Segment 1.

Table 2. Data requests for Segment 1.

Property Name	Engine Value
Patient-IdealBodyWeight(kg)	75.3
ExtracorporealMembraneOxygenationDevice-BloodFlow(L/min)	0.00
ExtracorporealMembraneOxygenationDevice-InletOxygenSaturation	0.00
ExtracorporealMembraneOxygenationDevice-OutletOxygenSaturation	0.00
ExtracorporealMembraneOxygenationDevice-MembraneLungOxygenContribution(mL/min)	0.00
ExtracorporealMembraneOxygenationDevice-MembraneLungCarbonDioxideContribution(mL/min)	0.00
ExtracorporealMembraneOxygenationDevice-HemoglobinConcentration(g/dL)	0.00
ExtracorporealMembraneOxygenationDevice-SweepGasFlow(L/min)	0.00
ExtracorporealMembraneOxygenationDevice-HydraulicTransmembranePressureGradient(mmHg)	0.00
ExtracorporealMembraneOxygenationDevice-InletPressure(mmHg)	0.00
ExtracorporealMembraneOxygenationDevice-OutletPressure(mmHg)	0.00
ExtracorporealMembraneOxygenationDevice-DrainagePressure(mmHg)	0.00
ExtracorporealMembraneOxygenationDevice-TransmembranePressureGradient(mmHg)	0.00
ExtracorporealMembraneOxygenationDevice-BagVolume(mL)	0.00
HeartRate(1/min)	106
HeartStrokeVolume(mL)	41.5
HeartEjectionFraction	0.419
BloodVolume(L)	4.14
ExtravascularFluidVolume(L)	34.1
MeanArterialPressure(mmHg)	90.9
SystolicArterialPressure(mmHg)	102
DiastolicArterialPressure(mmHg)	79.2
CardiacOutput(L/min)	4.39
HemoglobinContent(g)	616
CentralVenousPressure(mmHg)	2.99
PulmonaryCapillariesWedgePressure(mmHg)	4.28
TidalVolume(mL)	535
RespirationRate(1/min)	12.5
OxygenSaturation	0.975
CarbonDioxideSaturation	0.0262
EndTidalCarbonDioxideFraction	0.0493
EndTidalCarbonDioxidePressure(mmHg)	37.5
TotalAlveolarVentilation(L/min)	4.80
TranspulmonaryPressure(cmH2O)	5.88
CoreTemperature(degC)	37.1
SkinTemperature(degC)	31.0
RespiratoryExchangeRatio	0.785
OxygenConsumptionRate(mL/min)	312
CarbonDioxideProductionRate(mL/min)	245
GlomerularFiltrationRate(mL/min)	107
RenalBloodFlow(L/min)	0.888
UrineProductionRate(mL/min)	0.606
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0462
RightAfferentArterioleResistance(mmHg_min/mL)	0.0462
SystemicVascularResistance(mmHg_s/mL)	1.20
BloodPH	7.40
HorowitzIndex(mmHg)	437
Aorta-Oxygen-PartialPressure(mmHg)	91.6
Aorta-CarbonDioxide-PartialPressure(mmHg)	38.7
VenaCava-Oxygen-PartialPressure(mmHg)	31.7
VenaCava-CarbonDioxide-PartialPressure(mmHg)	45.9
RightTubules-Sodium-Concentration(g/L)	4.11
LeftTubules-Sodium-Concentration(g/L)	4.11
Oxygen-AlveolarTransfer(mL/min)	451
CarbonDioxide-AlveolarTransfer(mL/min)	-385

Segment 2

Stop the hemorrhages. VV-ECMO settings:

Inlet	Outlet	Pump Flow (L/min)	Sweep Gas Flow (L/min)	FiO2	CO2 Diffusing Capacity (mL/min/mmHg)	O2 Diffusing Capacity (mL/min/mmHg)	Supply Pressure (mmHg)	Compound	Bag Volume (mL)	Infuser Rate (L/min)
InternalJugular	CarotidArtery	4.0	3.0	1.0	20	10	500	Blood	500	300

Run for 10 min.

Table 3. Data request validation results for Segment 2.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
Aorta-Oxygen-PartialPressure(mmHg)	GreaterThan Segment1 (91.6)	793		765.29%	PaO2
Aorta-CarbonDioxide-PartialPressure(mmHg)	LessThan Segment1 (38.7)	39.4	1.73%		PaCO2
OxygenSaturation	GreaterThan Segment1 (0.975)	1.00		2.57%	SpO2

Figure 2. Vitals monitor for Segment 2.

Figure 3. Landing monitor for Segment 2.

Table 4. Data requests for Segment 2.

Property Name	Engine Value
Patient-IdealBodyWeight(kg)	75.3
ExtracorporealMembraneOxygenationDevice-BloodFlow(L/min)	4.00
ExtracorporealMembraneOxygenationDevice-InletOxygenSaturation	0.870
ExtracorporealMembraneOxygenationDevice-OutletOxygenSaturation	1.00
ExtracorporealMembraneOxygenationDevice-MembraneLungOxygenContribution(mL/min)	250
ExtracorporealMembraneOxygenationDevice-MembraneLungCarbonDioxideContribution(mL/min)	88.1
ExtracorporealMembraneOxygenationDevice-HemoglobinConcentration(g/dL)	14.7
ExtracorporealMembraneOxygenationDevice-SweepGasFlow(L/min)	3.00
ExtracorporealMembraneOxygenationDevice-HydraulicTransmembranePressureGradient(mmHg)	958
ExtracorporealMembraneOxygenationDevice-InletPressure(mmHg)	302
ExtracorporealMembraneOxygenationDevice-OutletPressure(mmHg)	236
ExtracorporealMembraneOxygenationDevice-DrainagePressure(mmHg)	-64.7
ExtracorporealMembraneOxygenationDevice-TransmembranePressureGradient(mmHg)	66.7
ExtracorporealMembraneOxygenationDevice-BagVolume(mL)	450
HeartRate(1/min)	57.5
HeartStrokeVolume(mL)	37.8
HeartEjectionFraction	0.396
BloodVolume(L)	4.21
ExtravascularFluidVolume(L)	34.1
MeanArterialPressure(mmHg)	95.6
SystolicArterialPressure(mmHg)	106
DiastolicArterialPressure(mmHg)	85.5
CardiacOutput(L/min)	2.18
HemoglobinContent(g)	620
CentralVenousPressure(mmHg)	1.86
PulmonaryCapillariesWedgePressure(mmHg)	4.10
TidalVolume(mL)	542
RespirationRate(1/min)	12.7
OxygenSaturation	1.00
CarbonDioxideSaturation	0.0258
EndTidalCarbonDioxideFraction	0.0325
EndTidalCarbonDioxidePressure(mmHg)	24.7
TotalAlveolarVentilation(L/min)	4.94
TranspulmonaryPressure(cmH2O)	4.92
CoreTemperature(degC)	37.1
SkinTemperature(degC)	30.4
RespiratoryExchangeRatio	0.817
OxygenConsumptionRate(mL/min)	313
CarbonDioxideProductionRate(mL/min)	256
GlomerularFiltrationRate(mL/min)	111
RenalBloodFlow(L/min)	1.15
UrineProductionRate(mL/min)	0.650
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0470
RightAfferentArterioleResistance(mmHg_min/mL)	0.0470
SystemicVascularResistance(mmHg_s/mL)	2.58
BloodPH	7.39
HorowitzIndex(mmHg)	3.87e+03
Aorta-Oxygen-PartialPressure(mmHg)	793
Aorta-CarbonDioxide-PartialPressure(mmHg)	39.4
VenaCava-Oxygen-PartialPressure(mmHg)	50.8
VenaCava-CarbonDioxide-PartialPressure(mmHg)	45.3
RightTubules-Sodium-Concentration(g/L)	4.03
LeftTubules-Sodium-Concentration(g/L)	4.03
Oxygen-AlveolarTransfer(mL/min)	-1.30e+03
CarbonDioxide-AlveolarTransfer(mL/min)	-127

Scenario Output Plots

Figure 4. Select outputs from the scenario.