Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

Authors

Charles Puelz, Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
Jonathan L. Marinaro, Department of Emergency Medicine and Critical Care, University of New Mexico, Albuquerque, New Mexico, USA
Yara A. Park, Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
Boyce E. Griffith, Department of Mathematics, University of North Carolina, Chapel Hill, North Carolina, USA Computational Medicine Program, University of North Carolina, Chapel Hill, North Carolina, USA McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, USA
Charles S. Peskin, Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
Jay S. Raval, Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USADepartment of Pathology, University of New Mexico, Albuquerque, New Mexico, USA

Document Type

Article

Publication Date

2-1-2021

Abstract

Vascular access connection configurations during tandem extracorporeal membrane oxygenation (ECMO) and therapeutic plasma exchange (TPE) may impact exchange kinetics. In these tandem procedures, typically the TPE inlet line is proximal to the TPE return line with respect to blood flow in the ECMO device, maximizing the opportunity for replacement fluid homogenization within the ECMO circuit. However, if TPE inlet and return line connections are switched, recirculation-a phenomenon in which replacement fluid leaving the TPE return line is prematurely drawn into the TPE inlet line prior to satisfactory homogenization within the ECMO circuit-will occur. Such recirculation could diminish TPE efficacy in patients on ECMO and mitigate therapeutic benefits. Using a mathematical model of recirculation in tandem ECMO and TPE, we demonstrate that the predicted impact of recirculation is negligible and vascular access connection positioning does not appear to be a point of clinical concern with regard to TPE kinetics.

Recommended Citation

Puelz C, Marinaro JL, Park YA, Griffith BE, Peskin CS, Raval JS. Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange. J Clin Apher. 2021 Feb;36(1):6-11. doi: 10.1002/jca.21805. Epub 2020 Oct 8. PMID: 33030779.