Effect of Upper body venoarterial extracorporeal membrane oxygenation on end-organ oxygen delivery in respiratory failure patients: a computational study

Extracorporeal membrane oxygenation (ECMO) is a vital technology increasingly deployed to maintain patients with profound respiratory failure as a bridge to transplantation. Patients with end-stage lung disease complicated by right ventricle failure, e.g. patients with interstitial pulmonary fibrosis, are challenging to support as they are not amenable to traditional cannulation strategies. Use of upper body venoarterial ECMO has been reported promising despite limited understanding of its effects on end-organ perfusion and the oxygenated blood distribution within the systemic circulation. Leveraging computational tools, we developed a model of upper body VA ECMO to quantify oxygen transport and distribution in the aortic tree of a patient-specific anatomy. Clinical flow waveforms and dynamic boundary conditions, i.e. lumped parameter models, were applied to maximize the outcome accuracy. Results revealed direct relation between ECMO flow share, geometrical morphology, as well as systematic vascular resistances and oxygen distribution of different vital organs. Comprehensive computational modeling, similar to the one presented here, offers indispensable platforms with the potential of providing invaluable clinical insights to enhance therapy planning and improve patient outcomes.