{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:32Z","timestamp":1787027672099,"version":"build-2736575974"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T00:00:00Z","timestamp":1747440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Economic Development","award":["F\/310117\/01\/X56"],"award-info":[{"award-number":["F\/310117\/01\/X56"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Veno-arterial extracorporeal membrane oxygenation (VA ECMO) for the management of refractory cardiogenic shock (CS) has been widely used in recent years. Increased left ventricular (LV) afterload induced by retrograde flow remains a limiting factor, which is particularly evident during peripheral VA ECMO support. The concomitant use of the intra-aortic balloon pump (IABP) is an established strategy to achieve LV unloading during VA ECMO support. Nevertheless, there remains controversy about the combined use of IABP during central or peripheral VA ECMO in terms of beneficial effects and outcome. We developed a simulation setting to study left ventricular unloading with IABP during peripheral and central VA ECMO using CARDIOSIM\u00a9, an established software simulator of the cardiovascular system. The aim was to quantitatively evaluate potential differences between the two VA ECMO configurations and ascertain the true beneficial effects compared to VA ECMO alone. The combined use of central VA ECMO and IABP decreased left ventricular end systolic volume and left ventricular end diastolic volume by 5\u201310%; right ventricular end systolic volume and right ventricular end diastolic volume by 10\u201320%; left atrial end systolic volume and left atrial end diastolic volume by 5\u201310%. Up to 25% reduction in mean left atrial pressure, up to 15% reduction in pulmonary capillary wedge pressure and up to 25% reduction in mean pulmonary arterial pressure was observed. From an energetic point of view, left ventricular external work decreased by 10\u201315% whilst up to 40%vreduction in right ventricular external work was observed. The findings make central VA ECMO plus IABP the most appropriate combination for left and right ventricle unloading.<\/jats:p>","DOI":"10.3390\/bioengineering12050540","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T07:34:03Z","timestamp":1747640043000},"page":"540","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Modelling and Simulation of the Interactions Between the Cardiovascular System and the Combined Use of VA ECMO and IABP: Comparison Between Peripheral and Central Configurations"],"prefix":"10.3390","volume":"12","author":[{"given":"Beatrice","family":"De Lazzari","sequence":"first","affiliation":[{"name":"Human Movement and Sport Sciences, University of Rome \u201cForo Italico\u201d, 00135 Rome, Italy"},{"name":"Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome \u201cForo Italico\u201d, 00135 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2351-9994","authenticated-orcid":false,"given":"Massimo","family":"Capoccia","sequence":"additional","affiliation":[{"name":"Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7887-5961","authenticated-orcid":false,"given":"Roberto","family":"Badagliacca","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal Anesthesiology and Cardiovascular Sciences, \u201cSapienza\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc O.","family":"Maybauer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35043 Marburg, Germany"},{"name":"Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD 4072, Australia"},{"name":"Division of Critical Care Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-4109","authenticated-orcid":false,"given":"Claudio","family":"De Lazzari","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology (IFC-CNR), National Research Council, 00185 Rome, Italy"},{"name":"Faculty of Medicine, Teaching University Geomedi, 0114 Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/ejhf.850","article-title":"Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life Support: A Review of the Current Literature","volume":"19","author":"Meani","year":"2017","journal-title":"Eur. J. Heart Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.xjtc.2022.02.039","article-title":"Extracorporeal Membrane Oxygenation and Left Ventricular Unloading: What Is the Evidence?","volume":"13","author":"Lorusso","year":"2022","journal-title":"JTCVS Tech."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S0735-1097(22)01945-3","article-title":"Outcomes of VA-ECMO plus IABP versus VA-ECMO Alone for Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock: Insight from the JROADDPC Registry","volume":"79","author":"Nishi","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/ejcts\/ezy304","article-title":"Effect of an Intra-Aortic Balloon Pump with Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Patients with Cardiogenic Shock: A Systematic Review and Meta-Analysis","volume":"55","author":"Li","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e006930","DOI":"10.1161\/CIRCINTERVENTIONS.118.006930","article-title":"Concomitant Intra-Aortic Balloon Pump Use in Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis","volume":"11","author":"Vallabhajosyula","year":"2018","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2876","DOI":"10.1053\/j.jvca.2022.02.006","article-title":"Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation with and without Intra-Aortic Balloon Pump","volume":"36","author":"Biancari","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1093\/icvts\/ivaa284","article-title":"Comparison of Left Ventricular Unloading Strategies on Venoarterial Extracorporeal Life Support","volume":"32","author":"Hasde","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lin, L.-Y., Liao, C.-W., Wang, C.-H., Chi, N.-H., Yu, H.-Y., Chou, N.-K., Hwang, J.-J., Lin, J.-L., Chiang, F.-T., and Chen, Y.-S. (2016). Effects of Additional Intra-Aortic Balloon Counter-Pulsation Therapy to Cardiogenic Shock Patients Supported by Extra-Corporeal Membranous Oxygenation. Sci. Rep., 6.","DOI":"10.1038\/srep23838"},{"key":"ref_9","first-page":"312","article-title":"Does Concurrent Use of Intra-Aortic Balloon Pumps Improve Survival in Patients with Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation?","volume":"30","author":"Wang","year":"2020","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/MAT.0000000000000788","article-title":"Clinical Outcomes and Reduced Pulmonary Artery Pressure With Intra-Aortic Balloon Pump During Central Extracorporeal Life Support","volume":"65","author":"Tepper","year":"2019","journal-title":"ASAIO J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Baran, C., Ozcinar, E., Kayan, A., Dikmen, N., Baran, C.S., and Inan, M.B. (2024). Comparison of ECMO, IABP and ECMO+ IABP in the Postoperative Period in Patients with Postcardiotomy Shock. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.3390\/jcdd11090283"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13613-019-0496-9","article-title":"Concurrent Initiation of Intra-Aortic Balloon Pumping with Extracorporeal Membrane Oxygenation Reduced in-Hospital Mortality in Postcardiotomy Cardiogenic Shock","volume":"9","author":"Chen","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jjcc.2021.10.011","article-title":"Prognostic Significance of Intra-Aortic Balloon Pumping Support in Patients with Acute Myocardial Infarction and Veno-Arterial Extracorporeal Membrane Oxygenation Therapy","volume":"79","author":"Kida","year":"2022","journal-title":"J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E136","DOI":"10.1111\/aor.12793","article-title":"Role of Intra-aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure after Cardiac Transplantation","volume":"40","author":"Loforte","year":"2016","journal-title":"Artif. Organs"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"961","DOI":"10.21037\/jtd.2017.03.73","article-title":"IABP plus ECMO\u2014Is One and One More than Two?","volume":"9","author":"Nuding","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zeng, P., Yang, C., Chen, J., Fan, Z., Cai, W., Huang, Y., Xiang, Z., Yang, J., Zhang, J., and Yang, J. (2022). Comparison of the Efficacy of ECMO with or without IABP in Patients with Cardiogenic Shock: A Meta-Analysis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.917610"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1177\/2048872617711169","article-title":"Intra-Aortic Balloon Pump Protects against Hydrostatic Pulmonary Oedema during Peripheral Venoarterial-Extracorporeal Membrane Oxygenation","volume":"7","author":"Demondion","year":"2018","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.athoracsur.2018.05.063","article-title":"Meta-Analysis of Peripheral or Central Extracorporeal Membrane Oxygenation in Postcardiotomy and Non-Postcardiotomy Shock","volume":"107","author":"Raffa","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2610","DOI":"10.1002\/ehf2.13981","article-title":"Intra-aortic Balloon Pump Impacts the Regional Haemodynamics of Patients with Cardiogenic Shock Treated with Femoro-femoral Veno-arterial Extracorporeal Membrane Oxygenation","volume":"9","author":"Xu","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1251","DOI":"10.1097\/CCM.0000000000002031","article-title":"Intraaortic Balloon Pulsation in Peripheral Venoarterial Extracorporeal Membrane Oxygenation: More Is Not Always Better","volume":"44","author":"Tay","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/1479-5876-12-106","article-title":"Effects of Intra-Aortic Balloon Pump on Cerebral Blood Flow during Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support","volume":"12","author":"Yang","year":"2014","journal-title":"J. Transl. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"R50","DOI":"10.1186\/cc11254","article-title":"Coronary versus Carotid Blood Flow and Coronary Perfusion Pressure in a Pig Model of Prolonged Cardiac Arrest Treated by Different Modes of Venoarterial ECMO and Intraaortic Balloon Counterpulsation","volume":"16","author":"Huptych","year":"2012","journal-title":"Crit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1177\/0310057X0903700517","article-title":"In Vivo Evaluation of Tissue Microflow under Combined Therapy with Extracorporeal Life Support and Intra-Aortic Balloon Counterpulsation","volume":"37","author":"Jung","year":"2009","journal-title":"Anaesth. Intensive Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1097\/CCM.0000000000000410","article-title":"Intra-Aortic Balloon Pump Effects on Macrocirculation and Microcirculation in Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation","volume":"42","author":"Petroni","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Djordjevic, I., Liakopoulos, O., Elskamp, M., Maier-Trauth, J., Gerfer, S., M\u00fchlbauer, T., Slottosch, I., Kuhn, E., Sabashnikov, A., and Rademann, P. (2022). Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation\u2014Results from a Large Animal Model. Life, 12.","DOI":"10.3390\/life12111859"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/MAT.0000000000001547","article-title":"Intra-Aortic Balloon Pump Use with Extra Corporeal Membrane Oxygenation\u2014A Mock Circulation Loop Study","volume":"68","author":"Farag","year":"2022","journal-title":"ASAIO J."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gerfer, S., Djordjevic, I., Maier, J., Movahed, A., Elskamp, M., Kuhn, E., Liakopoulos, O., Wahlers, T., and Deppe, A.C. (2023). Endothelial and Hemodynamic Function in a Large Animal Model in Relation to Different Extracorporeal Membrane Oxygenation Cannulation Strategies and Intra-Aortic Balloon Pumping. J. Clin. Med., 12.","DOI":"10.3390\/jcm12124038"},{"key":"ref_28","first-page":"717","article-title":"Hemodynamic Differences between Central ECMO and Peripheral ECMO: A Primary CFD Study","volume":"22","author":"Gu","year":"2016","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gu, K., Zhang, Z., Gao, B., Chang, Y., and Wan, F. (2018). Hemodynamic Effects of Perfusion Level of Peripheral ECMO on Cardiovascular System. Biomed. Eng. Online, 17.","DOI":"10.1186\/s12938-018-0493-5"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Gu, K., Gao, S., Zhang, Z., Ji, B., and Chang, Y. (2022). Hemodynamic Effect of Pulsatile on Blood Flow Distribution with VA ECMO: A Numerical Study. Bioengineering, 9.","DOI":"10.3390\/bioengineering9100487"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Reymond, P., Bendjelid, K., Giraud, R., Richard, G., Murith, N., Cikirikcioglu, M., and Huber, C. (2021). To Balloon or Not to Balloon? The Effects of an Intra-Aortic Balloon-Pump on Coronary Artery Flow during Extracorporeal Circulation Simulating Normal and Low Cardiac Output Syndromes. J. Clin. Med., 10.","DOI":"10.3390\/jcm10225333"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"De Lazzari, B., Badagliacca, R., Filomena, D., Papa, S., Vizza, C.D., Capoccia, M., and De Lazzari, C. (2022). CARDIOSIM\u00a9: The First Italian Software Platform for Simulation of the Cardiovascular System and Mechanical Circulatory and Ventilatory Support. Bioengineering, 9.","DOI":"10.20944\/preprints202206.0100.v1"},{"key":"ref_33","unstructured":"De Lazzari, C., and Staltieri, D. (2022, May 29). CARDIOSIM\u00a9 Website. Available online: https:\/\/Cardiosim.Dsb.Cnr.It."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1080\/10255842.2011.597354","article-title":"Interaction between the Septum and the Left (Right) Ventricular Free Wall in Order to Evaluate the Effects on Coronary Blood Flow: Numerical Simulation","volume":"15","year":"2012","journal-title":"Comput. Methods Biomech. Biomed. Engin."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Capoccia, M., Marconi, S., Singh, S.A., Pisanelli, D.M., and De Lazzari, C. (2018). Simulation as a Preoperative Planning Approach in Advanced Heart Failure Patients. A Retrospective Clinical Analysis. Biomed. Eng. Online, 17.","DOI":"10.1186\/s12938-018-0491-7"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"De Lazzari, B., Iacovoni, A., Mottaghy, K., Capoccia, M., Badagliacca, R., Vizza, C.D., and De Lazzari, C. (2021). ECMO Assistance during Mechanical Ventilation: Effects Induced on Energetic and Haemodynamic Variables. Comput. Methods Programs Biomed., 202, Erratum in Comput. Methods Programs Biomed. 2021, 212, 106478.","DOI":"10.1016\/j.cmpb.2021.106478"},{"key":"ref_37","unstructured":"De Lazzari, C., and De Lazzari, C. (2007). A Pumping Heart Coupled to Lumped Description of the Cardiovascular Compartments (CARDIOSIM\u00a9). Modelling Cardiovascular System and Mechanical Circulatory Support, CNR."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5430\/jbei.v4n2p8","article-title":"Decision-Making in Advanced Heart Failure Patients Requiring LVAD Insertion: Can Preoperative Simulation Become the Way Forward? A Case Study","volume":"4","author":"Capoccia","year":"2018","journal-title":"J. Biomed. Eng. Inform."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"De Lazzari, B., Capoccia, M., Badagliacca, R., Bozkurt, S., and De Lazzari, C. (2023). IABP versus Impella Support in Cardiogenic Shock: \u201cIn Silico\u201d Study. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.20944\/preprints202302.0105.v1"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e011991","DOI":"10.1161\/JAHA.119.011991","article-title":"Cardiogenic Shock","volume":"8","author":"Vahdatpour","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"100071","DOI":"10.1016\/j.chstcc.2024.100071","article-title":"The Management of Cardiogenic Shock From Diagnosis to Devices","volume":"2","author":"Alkhunaizi","year":"2024","journal-title":"A Narrat. Review. CHEST Crit. Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.jacc.2025.02.018","article-title":"2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Evaluation and Management of Cardiogenic Shock: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"85","author":"Sinha","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","first-page":"1","article-title":"Acute Haemodynamic Effects of Venoarterial Extracorporeal Membrane Oxygenation on Left Ventricular Mechano-energetics: The Ramp and Clamp Study","volume":"16","author":"Pankaj","year":"2021","journal-title":"Interv. Cardiol. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/02676591221149859","article-title":"The ProtekDuo dual-lumen cannula for temporary acute mechanical circulatory support in right heart failure: A systematic review","volume":"38","author":"Brewer","year":"2023","journal-title":"Perfusion"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/03913988221142904","article-title":"The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review","volume":"46","author":"Maybauer","year":"2023","journal-title":"Int. J. Artif. Organs"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Capoccia, M., Brewer, J.M., Rackauskas, M., Becker, T.K., Maybauer, D.M., Stukov, Y., Lorusso, R., and Maybauer, M.O. (2024). Outcome of Veno-Pulmonary Extracorporeal Life Support in Lung Transplantation Using ProtekDuo Cannula: A Systematic Review and Description of Configurations. J. Clin. Med., 13.","DOI":"10.37766\/inplasy2024.6.0053"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1525-1594.2007.00337.x","article-title":"The Acute Effect of Intra-aortic Balloon Counterpulsation during Extracorporeal Life Support: An Experimental Study","volume":"31","author":"Sauren","year":"2007","journal-title":"Artif. Organs"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1177\/0894318410371833","article-title":"The Limitations of Evidence-Based Practice","volume":"23","author":"Baumann","year":"2010","journal-title":"Nurs. Sci. Q."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.cardfail.2015.12.012","article-title":"Cardiovascular Simulation of Heart Failure Pathophysiology and Therapeutics","volume":"22","author":"Doshi","year":"2016","journal-title":"J. Card. Fail."},{"key":"ref_50","unstructured":"Saltarocchi, S. (2018). Simulation in Advanced Heart Failure with a View to Selection and Optimisation of Device Therapy. Int. J. Eng. Sci. Res. Tech. Thesis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3414\/ME0539","article-title":"Computer Simulation of Coronary Flow Waveforms during Caval Occlusion","volume":"48","author":"Neglia","year":"2009","journal-title":"Methods Inf. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1055\/s-0038-1633928","article-title":"In Vivo and Simulation Study of Artificial Ventilation Effects on Energetic Variables in Cardiosurgical Patients","volume":"44","author":"Darowski","year":"2005","journal-title":"Methods Inf. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1113\/jphysiol.2010.201558","article-title":"Systems biology and integrative physiological modelling","volume":"589","author":"Hester","year":"2011","journal-title":"J. Physiol."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/5\/540\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:34:22Z","timestamp":1760031262000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/5\/540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,17]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["bioengineering12050540"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering12050540","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,17]]}}}