title: A mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation support.
abstract: To develop a mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation (vv-ECMO).
  
  
  
  Total oxygen consumption, cardiac output, blood flow, recirculation, intrapulmonary shunt, hemoglobin, natural lung, and membrane lung oxygen fractions were chosen as inputs. Content, partial pressure, and hemoglobin saturation of oxygen in arterial, venous, pulmonary, and extracorporeal blood were outputs. To assess accuracy and predictive power of the model, we retrospectively analyzed data of 25 vv-ECMO patients. We compiled 2 software (with numerical, 2D and 3D graphical outputs) to study the impact of each variable on oxygenation.
  
  
  
  The model showed high accuracy and predictive power. Raising blood flow and oxygen fraction to the membrane lung or reducing total oxygen consumption improves arterial and venous oxygenation, especially in severe cases; raising oxygen fraction to the natural lung improves oxygenation only in milder cases; raising hemoglobin always improves oxygenation, especially in the venous district; recirculation fraction severely impairs oxygenation. In severely ill patients, increasing cardiac output worsens arterial oxygenation but enhances venous oxygenation. Oxygen saturation of ECMO inlet is critical to evaluate the appropriateness of oxygen delivery.
  
  
  
  The model with the software can be a useful teaching tool and a valuable decision-making aid for the management of hypoxic patients supported by vv-ECMO.
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan 20122 (MI), Italy; Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122 (MI), Italy. Electronic address: zanella.alb@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
authors.affiliation: School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza 20900 (MB), Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Salerno
authors.affiliation: School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza 20900 (MB), Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Scaravilli
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza 20900 (MB), Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Giani
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza 20900 (MB), Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Castagna
authors.affiliation: School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza 20900 (MB), Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Magni
authors.affiliation: Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122 (MI), Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Carlesso
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan 20122 (MI), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cadringher
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza 20900 (MB), Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Bombino
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan 20122 (MI), Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Grasselli
authors.affiliation: School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza 20900 (MB), Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza 20900 (MB), Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.affiliation: Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan 20122 (MI), Italy; Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122 (MI), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000328:Adult; D002302:Cardiac Output; D003661:Decision Support Techniques; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D008962:Models, Theoretical; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption; D010313:Partial Pressure; D012189:Retrospective Studies; D012984:Software
chemical_list: D010100:Oxygen
keywords: Blood circulation; Cardiac output; Extracorporeal circulation; Extracorporeal membrane oxygenation; Oxygen consumption; Theoretical models