Synchronized Cardiac Support with Veno-Pulmonary Extracorporeal Membrane Oxygenation in a Simulation Mannequin

Background: Extracorporeal membrane oxygenation (ECMO) traditionally delivers continuous flow, which may be associated with increased pulmonary edema and biotrauma. We hypothesized that electrocardiogram (ECG)-synchronized pulsatile flow may help mitigate these effects. Methods: We developed a benchtop mannequin simulating a veno-pulmonary (V-P) ECMO configuration, which enables direct return of oxygenated blood to the pulmonary artery and provides a controlled platform to evaluate pulmonary vascular responses. Using this model, we assessed the hemodynamic effects of pulsatile flow delivered by the iCOR (Xenios, Germany). Three clinical severity models were created with varying cardiac output, pulmonary vascular resistance (PVR), and heart rate. Each model was tested under standard ECMO and ECMO with the iCOR. Hemodynamic parameters were measured across various flow rates and iCOR settings. Results: In low-resistance models, iCOR effectively increased pulse pressure and reduced diastolic pulmonary artery pressure (PAP) compared to ECMO alone. As PVR increased, the benefits of iCOR were attenuated. Optimal pulse timing and strength were identified for each model, with the greatest effects seen under low to moderate resistance. High resistance and elevated flow rates reduced the effectiveness of pulsatile support. Conclusion: ECG-synchronized pulsatile flow via iCOR modulated PAP in a resistance-dependent manner. Pulsatile flow enhanced hemodynamics and showed potential to reduce right ventricular afterload under low-resistance conditions. These findings highlight the need for individualized ECMO and iCOR strategies based on pulmonary hemodynamics.