Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance
Abstract Clinical adoption of mechanical circulatory support for shock is rapidly expanding. Achieving optimal therapeutic benefit requires metrics of state to guide titration and weaning of support. Using the transvalvular positioning of a percutaneous ventricular assist device (pVAD), device:hear...
| Main Authors: | , , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | English |
| Published: |
Springer International Publishing
2021
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| Online Access: | https://hdl.handle.net/1721.1/131452 |
| _version_ | 1811083836676636672 |
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| author | Keller, Steven P Chang, Brian Y Tan, Qing Zhang, Zhengyang El Katerji, Ahmad Edelman, Elazer R |
| author2 | Massachusetts Institute of Technology. Institute for Medical Engineering & Science |
| author_facet | Massachusetts Institute of Technology. Institute for Medical Engineering & Science Keller, Steven P Chang, Brian Y Tan, Qing Zhang, Zhengyang El Katerji, Ahmad Edelman, Elazer R |
| author_sort | Keller, Steven P |
| collection | MIT |
| description | Abstract
Clinical adoption of mechanical circulatory support for shock is rapidly expanding. Achieving optimal therapeutic benefit requires metrics of state to guide titration and weaning of support. Using the transvalvular positioning of a percutaneous ventricular assist device (pVAD), device:heart interactions are leveraged to determine cardiac output (CO) and systemic vascular resistance (SVR) near-continuously without disrupting therapeutic function. An automated algorithm rapidly alternates between device support levels to dynamically modulate physiological response. Employing a two-element lumped parameter model of the vasculature, SVR and CO are quantified directly from measurements obtained by the pVAD without external calibration or invasive catheters. The approach was validated in an acute porcine model across a range of cardiac (CO = 3–10.6 L/min) and vascular (SVR = 501–1897 dyn s/cm5) states. Cardiac output calculations closely correlated (r = 0.82) to measurements obtained by the pulmonary artery catheter-based thermodilution method with a mean bias of 0.109 L/min and limits of agreement from − 1.67 to 1.89 L/min. SVR was also closely correlated (r = 0.86) to traditional catheter-based measurements with a mean bias of 62.1 dyn s/cm5 and limits of agreement from − 260 to 384 dyn s/cm5. Use of diagnostics integrated into therapeutic device function enables the potential for optimizing support to improve outcomes for cardiogenic shock. |
| first_indexed | 2024-09-23T12:40:07Z |
| format | Article |
| id | mit-1721.1/131452 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T12:40:07Z |
| publishDate | 2021 |
| publisher | Springer International Publishing |
| record_format | dspace |
| spelling | mit-1721.1/1314522024-03-19T13:58:33Z Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance Keller, Steven P Chang, Brian Y Tan, Qing Zhang, Zhengyang El Katerji, Ahmad Edelman, Elazer R Massachusetts Institute of Technology. Institute for Medical Engineering & Science Abstract Clinical adoption of mechanical circulatory support for shock is rapidly expanding. Achieving optimal therapeutic benefit requires metrics of state to guide titration and weaning of support. Using the transvalvular positioning of a percutaneous ventricular assist device (pVAD), device:heart interactions are leveraged to determine cardiac output (CO) and systemic vascular resistance (SVR) near-continuously without disrupting therapeutic function. An automated algorithm rapidly alternates between device support levels to dynamically modulate physiological response. Employing a two-element lumped parameter model of the vasculature, SVR and CO are quantified directly from measurements obtained by the pVAD without external calibration or invasive catheters. The approach was validated in an acute porcine model across a range of cardiac (CO = 3–10.6 L/min) and vascular (SVR = 501–1897 dyn s/cm5) states. Cardiac output calculations closely correlated (r = 0.82) to measurements obtained by the pulmonary artery catheter-based thermodilution method with a mean bias of 0.109 L/min and limits of agreement from − 1.67 to 1.89 L/min. SVR was also closely correlated (r = 0.86) to traditional catheter-based measurements with a mean bias of 62.1 dyn s/cm5 and limits of agreement from − 260 to 384 dyn s/cm5. Use of diagnostics integrated into therapeutic device function enables the potential for optimizing support to improve outcomes for cardiogenic shock. 2021-09-20T17:17:08Z 2021-09-20T17:17:08Z 2020-04-13 2020-09-24T21:14:25Z Article http://purl.org/eprint/type/JournalArticle https://hdl.handle.net/1721.1/131452 en https://doi.org/10.1007/s10439-020-02510-3 Creative Commons Attribution-Noncommercial-Share Alike http://creativecommons.org/licenses/by-nc-sa/4.0/ Biomedical Engineering Society application/pdf Springer International Publishing Springer International Publishing |
| spellingShingle | Keller, Steven P Chang, Brian Y Tan, Qing Zhang, Zhengyang El Katerji, Ahmad Edelman, Elazer R Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance |
| title | Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance |
| title_full | Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance |
| title_fullStr | Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance |
| title_full_unstemmed | Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance |
| title_short | Dynamic Modulation of Device-Arterial Coupling to Determine Cardiac Output and Vascular Resistance |
| title_sort | dynamic modulation of device arterial coupling to determine cardiac output and vascular resistance |
| url | https://hdl.handle.net/1721.1/131452 |
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