CARDIOSIM© Cardiovascular Software Simulator for the Study of ECMO Support and Mechanical Ventilation Interaction.

The management of ventilated patients on extracorporeal membrane oxygenation (ECMO) support can be quite complex. This chapter will focus on the management of these patients based on the analysis of haemodynamic and energetic parameters using numerical simulations generated by a software package named CARDIOSIM©. New modules of the systemic circulation and ECMO were implemented in CARDIOSIM© software, a modular simulator of the cardiovascular system used in research, clinical and e-learning environment. The new structure of the developed modules is based on the concept of lumped (0-D) numerical modelling. Different ECMO configurations have been connected to the cardiovascular network to reproduce veno-arterial (VA) and veno-venous (VV) ECMO assistance. The advantages and limitations of different ECMO cannulation strategies have been considered. Literature data to validate the effects of a combined ventilation and ECMO support strategy were used. The outcome of the simulations has shown the typical effects induced during mechanical ventilation and ECMO assistance. We have focused our attention on ECMO with triple cannulation such as veno-ventricular-arterial (VV-A) and veno-atrial-arterial (VA-A) configurations to improve the haemodynamic and energetic conditions of a virtual patient. Simulations of VV-A and VA-A assistance with and without mechanical ventilation have generated specific effects on cardiac output, coupling of arterial and ventricular elastance for both ventricles, mean pulmonary artery pressure, external work and pressure volume area. The new modules used in this context have shown great potential for the purpose of this study. Based on our clinical experience during the COVID-19 pandemic, numerical simulations may help clinicians with data analysis and treatment optimisation of patients requiring both mechanical ventilation and circulatory support.