ECMO-VV
ECMO VV
Description
This validation scenario simulates the management of a patient with severe ARDS using mechanical ventilation and VV ECMO support per ELSO guidelines [237] [381] [29]. The scenario includes the induction of bilateral ARDS, tracheal intubation, and VV ECMO initiation using femoral venous drainage (tip in the IVC) and right IJ venous return (tip in the RA), consistent with common adult VV ECMO configurations.
Segment Validation
Segment 1
Induce bilateral severe ARDS at severity 0.95 in both lungs. This represents the worst end of the ARDS spectrum and is consistent with the physiologic criteria for VV ECMO candidacy per ELSO guidelines. Establish tracheal intubation for mechanical ventilation access. ARDSNet VC-CMV: VT 6 mL/kg PBW, RR 25 bpm, PEEP 12 cmH2O per high PEEP/FiO2 table at FiO2 1.0, flow 60 L/min square wave. Severely reduced lung compliance from ARDS is expected to produce plateau pressures well above 30 cmH2O despite guideline-compliant tidal volumes. This refractory elevation of Pplat is the clinical indication for ECMO. Advance to homeostasis under ARDSNet ventilation before reading comparison values.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| MechanicalVentilator-TidalVolume(mL) | EqualTo 450 [29] | 440 | -2.25% | ARDSNet VT = ~6 mL/kg PBW | |
| MechanicalVentilator-RespirationRate(1/min) | [20.0,30.0] [29] | 25.0 | 0.00% | ARDSNet balanced RR for severe ARDS | |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | [11.0,13.0] [29] | 12.0 | 0.00% | PEEP per ARDSNet high PEEP/FiO2 table at FiO2 1.0 | |
| MechanicalVentilator-PlateauPressure(cmH2O) | GreaterThan 30 [29] | 32.2 | 7.17% | Elevated Pplat confirms ECMO indication despite ARDSNet-compliant VT | |
| OxygenSaturation | LessThan 0.93 [29] [237] | 0.889 | -4.41% | SaO2 < 93% confirms clinically significant hypoxemia consistent with PaO2/FiO2 < 80 mmHg | |
| BloodPH | LessThan 7.25 [381] | 7.20 | -0.70% | pH < 7.25 meets ELSO hypercapnic respiratory failure ECMO indication | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | GreaterThan 60 [381] | 64.1 | 6.82% | PaCO2 >= 60 mmHg meets ELSO hypercapnic ECMO indication | |
| HorowitzIndex(mmHg) | LessThan 80 [381] | 61.4 | -23.26% | PaO2/FiO2 < 80 mmHg meets ELSO/EOLIA hypoxemic ECMO indication | |
| MeanArterialPressure(mmHg) | GreaterThan 50 [237] | 96.4 | 92.76% | Minimum MAP confirming patient is not in irreversible collapse pre-cannulation |
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| 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 |
| MechanicalVentilator-AirwayPressure(cmH2O) | 12.0 |
| MechanicalVentilator-BreathState | 6.00 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 13.6 |
| MechanicalVentilator-EndTidalCarbonDioxideFraction | 0.0486 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 37.4 |
| MechanicalVentilator-EndTidalOxygenFraction | 0.951 |
| MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 731 |
| MechanicalVentilator-ExpiratoryFlow(L/min) | 3.92 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 13.5 |
| MechanicalVentilator-ExpiratoryTidalVolume(mL) | 440 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 12.0 |
| MechanicalVentilator-InspiratoryExpiratoryRatio | 0.250 |
| MechanicalVentilator-InspiratoryFlow(L/min) | -3.92 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 13.5 |
| MechanicalVentilator-InspiratoryTidalVolume(mL) | 440 |
| MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.0301 |
| MechanicalVentilator-LeakFraction | 3.09e-14 |
| MechanicalVentilator-MeanAirwayPressure(cmH2O) | 16.6 |
| MechanicalVentilator-PeakExpiratoryFlow(L/min) | 64.7 |
| MechanicalVentilator-PeakInspiratoryFlow(L/min) | 60.0 |
| MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 44.2 |
| MechanicalVentilator-PlateauPressure(cmH2O) | 32.2 |
| MechanicalVentilator-RespirationRate(1/min) | 25.0 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 21.9 |
| MechanicalVentilator-TidalVolume(mL) | 440 |
| MechanicalVentilator-TotalLungVolume(mL) | 17.9 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 12.0 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 11.0 |
| HeartRate(1/min) | 134 |
| HeartStrokeVolume(mL) | 48.5 |
| HeartEjectionFraction | 0.430 |
| BloodVolume(L) | 5.47 |
| ExtravascularFluidVolume(L) | 34.1 |
| MeanArterialPressure(mmHg) | 96.4 |
| SystolicArterialPressure(mmHg) | 109 |
| DiastolicArterialPressure(mmHg) | 83.5 |
| CardiacOutput(L/min) | 6.48 |
| HemoglobinContent(g) | 827 |
| CentralVenousPressure(mmHg) | 4.67 |
| PulmonaryCapillariesWedgePressure(mmHg) | 4.98 |
| TidalVolume(mL) | 440 |
| RespirationRate(1/min) | 25.0 |
| OxygenSaturation | 0.889 |
| CarbonDioxideSaturation | 0.543 |
| EndTidalCarbonDioxideFraction | 0.0550 |
| EndTidalCarbonDioxidePressure(mmHg) | 42.4 |
| TotalAlveolarVentilation(L/min) | 2.46 |
| TranspulmonaryPressure(cmH2O) | 20.4 |
| CoreTemperature(degC) | 36.8 |
| SkinTemperature(degC) | 29.7 |
| RespiratoryExchangeRatio | 0.812 |
| OxygenConsumptionRate(mL/min) | 255 |
| CarbonDioxideProductionRate(mL/min) | 207 |
| GlomerularFiltrationRate(mL/min) | 77.5 |
| RenalBloodFlow(L/min) | 1.00 |
| UrineProductionRate(mL/min) | 1.02 |
| LeftAfferentArterioleResistance(mmHg_min/mL) | 0.0389 |
| RightAfferentArterioleResistance(mmHg_min/mL) | 0.0389 |
| SystemicVascularResistance(mmHg_s/mL) | 0.848 |
| BloodPH | 7.20 |
| HorowitzIndex(mmHg) | 61.4 |
| Aorta-Oxygen-PartialPressure(mmHg) | 61.3 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 64.1 |
| VenaCava-Oxygen-PartialPressure(mmHg) | 41.5 |
| VenaCava-CarbonDioxide-PartialPressure(mmHg) | 72.8 |
| RightTubules-Sodium-Concentration(g/L) | 4.02 |
| LeftTubules-Sodium-Concentration(g/L) | 4.02 |
| Oxygen-AlveolarTransfer(mL/min) | 202 |
| CarbonDioxide-AlveolarTransfer(mL/min) | -201 |
Segment 2
Initiate VV ECMO via IVC drainage cannula (femoral) and RA return cannula (right IJ). Pump flow 5.0 L/min targets adequate O2 delivery for a 70-80 kg adult per ELSO oxygen delivery calculations. Sweep gas flow set to 5.0 L/min per [381] recommendation for controlled CO2 normalization from hypercapnic baseline, avoiding rapid pH shifts and respiratory alkalosis. Sweep gas FiO2 titrated to 80% per [237] oxygenation guidelines to target PaO2 55-100 mmHg. CESAR-protocol PC-CMV lung rest after ECMO initiation: driving pressure 10 cmH2O above PEEP (PIP 20 cmH2O), PEEP 10 cmH2O, RR 10 bpm, I:E 1:1 (Ti 3.0s), FiO2 0.3. Settings match the CESAR trial lung rest protocol [302] as cited in Tonna et al [381]. The ECMO circuit assumes primary responsibility for gas exchange; the ventilator maintains minimal lung inflation only. Advance to homeostasis under combined VV ECMO and lung-rest ventilation before reading comparison values.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| MechanicalVentilator-TidalVolume(mL) | LessThan 300 [381] | 221 | -26.24% | Ultra-protective VT below 4 mL/kg PBW during ECMO lung rest | |
| MechanicalVentilator-RespirationRate(1/min) | [4.00,15.0] [381] | 10.0 | 0.00% | Reduced RR per ELSO lung rest; circuit handles CO2 elimination | |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | [9.00,11.0] [381] | 10.0 | 0.00% | PEEP >= 10 cmH2O per ELSO Table 3 to prevent atelectasis during ECMO | |
| MechanicalVentilator-PlateauPressure(cmH2O) | LessThan Segment1 (32.2) [381] [29] | 20.4 | -36.48% | Pplat significantly reduced vs. pre-ECMO segment confirming lung rest | |
| MechanicalVentilator-PlateauPressure(cmH2O) | LessThan 25 [381] [29] | 20.4 | -18.32% | Pplat absolute ceiling per ELSO lung rest protocol | |
| BloodPH | [7.35,7.45] [381] | 7.35 | -0.02% | Normal pH confirms ECMO CO2 clearance has restored acid-base balance | |
| Aorta-Oxygen-PartialPressure(mmHg) | [55.0,100] [381] | 95.5 | 0.00% | PaO2 target range during active VV ECMO support | |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | [35.0,45.0] [381] | 43.9 | 0.00% | Eucapnia achieved via sweep gas titration at 5.0 L/min | |
| OxygenSaturation | GreaterThan 0.80 [381] [237] | 0.976 | 21.95% | SaO2 80-90% is expected and appropriate on VV ECMO; do not chase higher values | |
| HorowitzIndex(mmHg) | GreaterThan Segment1 (61.4) [381] | 332 | 440.68% | PaO2/FiO2 improved vs. pre-ECMO confirming circuit augments oxygenation | |
| MeanArterialPressure(mmHg) | GreaterThan 65 [381] | 96.0 | 47.64% | MAP >= 65 mmHg per ELSO hemodynamic target on VV ECMO | |
| ExtracorporealMembraneOxygenationDevice-BloodFlow(L/min) | [4.00,6.00] [381] | 5.00 | 0.00% | Circuit flow 4-6 L/min meets adult O2 delivery requirements per ELSO | |
| ExtracorporealMembraneOxygenationDevice-SweepGasFlow(L/min) | [1.00,10.0] [381] [237] | 5.00 | 0.00% | Sweep gas 1-9+ L/min per ELSO; set at 1:1 gas-to-blood ratio | |
| ExtracorporealMembraneOxygenationDevice-DrainagePressure(mmHg) | GreaterThanEqualTo -300 [237] | -80.0 | 73.34% | Inlet suction must not exceed -300 mmHg to prevent hemolysis | |
| ExtracorporealMembraneOxygenationDevice-OutletPressure(mmHg) | LessThan 400 [237] | 202 | -49.62% | Outlet pressure must remain below 400 mmHg to prevent circuit blowout |
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| Property Name | Engine Value |
|---|---|
| Patient-IdealBodyWeight(kg) | 75.3 |
| ExtracorporealMembraneOxygenationDevice-BloodFlow(L/min) | 5.00 |
| ExtracorporealMembraneOxygenationDevice-InletOxygenSaturation | 0.796 |
| ExtracorporealMembraneOxygenationDevice-OutletOxygenSaturation | 0.992 |
| ExtracorporealMembraneOxygenationDevice-MembraneLungOxygenContribution(mL/min) | 222 |
| ExtracorporealMembraneOxygenationDevice-MembraneLungCarbonDioxideContribution(mL/min) | 192 |
| ExtracorporealMembraneOxygenationDevice-HemoglobinConcentration(g/dL) | 15.1 |
| ExtracorporealMembraneOxygenationDevice-SweepGasFlow(L/min) | 5.00 |
| ExtracorporealMembraneOxygenationDevice-HydraulicTransmembranePressureGradient(mmHg) | 475 |
| ExtracorporealMembraneOxygenationDevice-InletPressure(mmHg) | 285 |
| ExtracorporealMembraneOxygenationDevice-OutletPressure(mmHg) | 202 |
| ExtracorporealMembraneOxygenationDevice-DrainagePressure(mmHg) | -80.0 |
| ExtracorporealMembraneOxygenationDevice-TransmembranePressureGradient(mmHg) | 83.3 |
| ExtracorporealMembraneOxygenationDevice-BagVolume(mL) | 500 |
| MechanicalVentilator-AirwayPressure(cmH2O) | 10.0 |
| MechanicalVentilator-BreathState | 6.00 |
| MechanicalVentilator-DynamicRespiratoryCompliance(mL/cmH2O) | 22.1 |
| MechanicalVentilator-EndTidalCarbonDioxideFraction | 0.0328 |
| MechanicalVentilator-EndTidalCarbonDioxidePressure(mmHg) | 25.2 |
| MechanicalVentilator-EndTidalOxygenFraction | 0.256 |
| MechanicalVentilator-EndTidalOxygenPressure(mmHg) | 197 |
| MechanicalVentilator-ExpiratoryFlow(L/min) | 0.0424 |
| MechanicalVentilator-ExpiratoryResistance(cmH2O_s/L) | 13.5 |
| MechanicalVentilator-ExpiratoryTidalVolume(mL) | 221 |
| MechanicalVentilator-ExtrinsicPositiveEndExpiratoryPressure(cmH2O) | 10.0 |
| MechanicalVentilator-InspiratoryExpiratoryRatio | 1.00 |
| MechanicalVentilator-InspiratoryFlow(L/min) | -0.0424 |
| MechanicalVentilator-InspiratoryResistance(cmH2O_s/L) | 13.5 |
| MechanicalVentilator-InspiratoryTidalVolume(mL) | 221 |
| MechanicalVentilator-IntrinsicPositiveEndExpiratoryPressure(cmH2O) | 0.000297 |
| MechanicalVentilator-LeakFraction | 2.09e-13 |
| MechanicalVentilator-MeanAirwayPressure(cmH2O) | 15.0 |
| MechanicalVentilator-PeakExpiratoryFlow(L/min) | 34.2 |
| MechanicalVentilator-PeakInspiratoryFlow(L/min) | 33.8 |
| MechanicalVentilator-PeakInspiratoryPressure(cmH2O) | 20.0 |
| MechanicalVentilator-PlateauPressure(cmH2O) | 20.4 |
| MechanicalVentilator-RespirationRate(1/min) | 10.0 |
| MechanicalVentilator-StaticRespiratoryCompliance(mL/cmH2O) | 21.2 |
| MechanicalVentilator-TidalVolume(mL) | 221 |
| MechanicalVentilator-TotalLungVolume(mL) | 0.188 |
| MechanicalVentilator-TotalPositiveEndExpiratoryPressure(cmH2O) | 10.0 |
| MechanicalVentilator-TotalPulmonaryVentilation(L/min) | 2.21 |
| HeartRate(1/min) | 59.3 |
| HeartStrokeVolume(mL) | 110 |
| HeartEjectionFraction | 0.634 |
| BloodVolume(L) | 5.42 |
| ExtravascularFluidVolume(L) | 34.1 |
| MeanArterialPressure(mmHg) | 96.0 |
| SystolicArterialPressure(mmHg) | 121 |
| DiastolicArterialPressure(mmHg) | 67.8 |
| CardiacOutput(L/min) | 6.55 |
| HemoglobinContent(g) | 818 |
| CentralVenousPressure(mmHg) | 3.36 |
| PulmonaryCapillariesWedgePressure(mmHg) | 8.07 |
| TidalVolume(mL) | 221 |
| RespirationRate(1/min) | 10.0 |
| OxygenSaturation | 0.976 |
| CarbonDioxideSaturation | 0.0978 |
| EndTidalCarbonDioxideFraction | 0.0444 |
| EndTidalCarbonDioxidePressure(mmHg) | 34.1 |
| TotalAlveolarVentilation(L/min) | 0.00 |
| TranspulmonaryPressure(cmH2O) | 19.2 |
| CoreTemperature(degC) | 36.8 |
| SkinTemperature(degC) | 29.4 |
| RespiratoryExchangeRatio | 0.811 |
| OxygenConsumptionRate(mL/min) | 256 |
| CarbonDioxideProductionRate(mL/min) | 208 |
| GlomerularFiltrationRate(mL/min) | 146 |
| RenalBloodFlow(L/min) | 1.48 |
| UrineProductionRate(mL/min) | 0.881 |
| LeftAfferentArterioleResistance(mmHg_min/mL) | 0.0407 |
| RightAfferentArterioleResistance(mmHg_min/mL) | 0.0407 |
| SystemicVascularResistance(mmHg_s/mL) | 0.848 |
| BloodPH | 7.35 |
| HorowitzIndex(mmHg) | 332 |
| Aorta-Oxygen-PartialPressure(mmHg) | 95.5 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 43.9 |
| VenaCava-Oxygen-PartialPressure(mmHg) | 41.3 |
| VenaCava-CarbonDioxide-PartialPressure(mmHg) | 46.7 |
| RightTubules-Sodium-Concentration(g/L) | 4.03 |
| LeftTubules-Sodium-Concentration(g/L) | 4.03 |
| Oxygen-AlveolarTransfer(mL/min) | 32.5 |
| CarbonDioxide-AlveolarTransfer(mL/min) | -2.71 |
Scenario Output Plots
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