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Less invasive and inotrope-reduction approach to automated closed-loop control of hemodynamics in decompensated heart failure

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Kazunori Uemura, Toru Kawada, Can Zheng, Masaru Sugimachi, Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center

Less invasive and inotrope-reduction

Heart failure (HF) is a global pandemic problem, and requires complicated hemodynamic management to rescue the victims. In order to reduce the stress and work imposed on physicians who are occupied in the treatment of patients with HF, we have been developing a closed-loop automated infusion system of cardiovascular drugs to automatically improve the hemodynamics in HF. In this study, we have developed a clinically feasible system by extending the previously develop prototype system. We integrated to the system minimally invasive monitors of hemodynamic variables such as cardiac output and pulmonary wedge pressure that we developed recently. We also redesigned the control logic of the system to reduce the use of inotropic drugs, use of which is strictly limited in recent clinical practice. We applied the newly developed system to 9 dogs with decompensated HF. Once activated, our system started to control the infusion of vasodilator and diuretics in all the animals. Inotropic drug was not infused in 3 animals, and infused at minimal doses in 6 animals that were intolerant of vasodilator infusion alone. Within 50 min, our system controlled the hemodynamic variables to their respective targets accurately. In a minimally invasive setting while reducing the use of inotropic drug, our system succeeded in automatically optimizing the overall hemodynamics in canine models of HF. The present results undoubtedly pave the way for clinical application of our automated drug infusion system, which may enable fully-automated but appropriate hemodynamic management of HF patients even by inexperienced physicians or nurses.

Keywords: hemodynamics, heart failure, closed-loop control, cardiovascular drugs

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