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Ahmad F, Cheema TA, Rehman K, Ullah M, Jamil M, Park CW. Hemodynamic performance evaluation of neonatal ECMO double lumen cannula using fluid-structure interaction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3706. [PMID: 37039384 DOI: 10.1002/cnm.3706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/30/2022] [Accepted: 03/19/2023] [Indexed: 06/07/2023]
Abstract
Extra corporeal membrane oxygenation (ECMO) is an artificial oxygenation facility, employed in situations of cardio-pulmonary failure. Some diseases i.e., acute respiratory distress syndrome, pulmonary hypertension, corona virus disease (COVID-19) etc. affect oxygenation performance of the lungs thus requiring the need of artificial oxygenation. Critical care teams used ECMO technique during the COVID-19 pandemic to support the heart and lungs of COVID-19 patients who had an acute respiratory or cardiac failure. Double Lumen Cannula (DLC) is one of the most critical components of ECMO as it resides inside the patient and, connects patient with external oxygenation circuit. DLC facilitates delivery and drainage of blood from the patient's body. DLC is characterized by delicate balance of internal and external flows inside a limited space of the right atrium (RA). An optimal performance of the DLC necessitates structural stability under biological and hemodynamic loads, a fact that has been overlooked by previously published studies. In the past, many researchers experimentally and computationally investigated the hemodynamic performance of DLC by employing Eulerian approach, which evaluate instantaneous blood damage without considering blood shear exposure history (qualitative assessment only). The present study is an attempt to address the aforementioned limitations of the previous studies by employing Lagrangian (quantitative assessment) and incorporating the effect of fluid-structure interaction (FSI) to study the hemodynamic performance of neonatal DLC. The study was performed by solving three-dimensional continuity, momentum, and structural mechanics equation(s) by numerical methods for the blood flow through neonatal DLC. A two-way coupled FSI analysis was performed to analyze the effect of DLC structural deformation on its hemodynamic performance. Results show that the return lumen was the most critical section with maximum pressure drop, velocity, shear stresses, and blood damage. Recirculation and residence time of blood in the right atrium (RA) increases with increasing blood flow rates. Considering the structural deformation has led to higher blood damage inside the DLC-atrium system. Maximum Von-Mises stress was present on the side edges of the return lumen that showed direct proportionality with the blood flow rate.
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Affiliation(s)
- Faiq Ahmad
- Faculty of Mechanical Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Taqi Ahmad Cheema
- Faculty of Mechanical Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Khawar Rehman
- Department of Civil and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea
- Department of Civil Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Minhaj Ullah
- Faculty of Mechanical Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Muhammad Jamil
- Analysis Group, Starfish Medical, 455 Boleskine Rd, Victoria, British Columbia, Canada
- Department of Mechanical Engineering, KoÇ University, Sariyar, Istanbul, 34450, Turkey
| | - Cheol Woo Park
- School of Mechanical Engineering, Kyungpook National University, 80 Daehak-Ro, Buk-Gu, Daegu, 41566, South Korea
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Wickramarachchi A, Khamooshi M, Burrell A, Pellegrino VA, Kaye DM, Gregory SD. The effect of drainage cannula tip position on risk of thrombosis during venoarterial extracorporeal membrane oxygenation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107407. [PMID: 36764061 DOI: 10.1016/j.cmpb.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Venoarterial extracorporeal membrane oxygenation (VA ECMO) is able to support critically ill patients undergoing refractory cardiopulmonary failure. It relies on drainage cannulae to extract venous blood from the patient, but cannula features and tip position may impact flow dynamics and thrombosis risk. Therefore, this study aimed to investigate the effect of tip position of single-stage (SS) and multi-stage (MS) VA ECMO drainage cannulae on the risk of thrombosis. METHODS Computational fluid dynamics was used to model flow dynamics within patient-specific geometry of the venous vasculature. The tip of the SS and MS cannula was placed in the superior vena cava (SVC), SVC-Right atrium (RA) junction, mid-RA, inferior vena cava (IVC)-RA junction, and IVC. The risk of thrombosis was assessed by measuring several factors. Blood residence time was measured via an Eulerian approach through the use of a scalar source term. Regions of stagnant volume were recognised by identifying regions of low fluid velocity and shear rate. Rate of blood washout was calculated by patching the domain with a scalar value and measuring the rate of fluid displacement. Lastly, wall shear stress values were determined to provide a qualitative understanding of potential blood trauma. RESULTS Thrombosis risk varied substantially with position changes of the SS cannula, which was less evident with the MS cannula. The SS cannula showed reduced thrombosis risk arising from stagnant regions when placed in the SVC or SVC-RA junction, whereas an MS cannula was predicted to create stagnant regions during all tip positions. When positioned in the IVC-RA junction or IVC, the risk of thrombosis was higher in the SS cannula than in the MS cannula due to both high and low shear flow. CONCLUSION Tip position of the drainage cannula impacts cannula flow dynamics and, subsequently, the risk of thrombosis. The use of MS cannulae can reduce high shear-related thrombosis, but SS cannulae can eliminate stagnant regions when advanced into the SVC. Therefore, the choice of cannula design and tip position should be carefully considered during cannulation.
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Affiliation(s)
- Avishka Wickramarachchi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia.
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
| | - Aidan Burrell
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | | | - David M Kaye
- The Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Shaun D Gregory
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
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3
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Fiusco F, Rorro F, Broman LM, Prahl Wittberg L. Numerical and experimental investigation of a lighthouse tip drainage cannula used in extracorporeal membrane oxygenation. Artif Organs 2023; 47:330-341. [PMID: 36227654 PMCID: PMC10092507 DOI: 10.1111/aor.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/31/2022] [Accepted: 10/05/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation is a life-saving therapy used in case of acute respiratory/circulatory failure. Exposure of blood to non-physiological surfaces and high shear stresses is related to hemolytic damage and platelet activation. A detailed knowledge of the fluid dynamics of the components under different scenarios is thus paramount to assess the thrombogenicity of the circuit. METHODS An investigation of the flow structures developing in a conventional lighthouse tip (single-staged) drainage cannula was performed with cross-validated computational fluid dynamics and particle image velocimetry. The aim was to quantify the variation in drainage performance and stress levels induced by different fluid models, hematocrit and vessel-to-cannula flow rate ratios. RESULTS The results showed that the 90° bends of the flow through the side holes created a recirculation zone inside the cannula which increased residence time. Flow structures resembling a jet in a crossflow were also observed. The use of different hematocrits did not significantly affect drainage performances. The most proximal set of holes drained the largest fraction of fluid. However, different flow rate ratios altered the flow rate drained through the tip. The use of 2D data led to a 50% underestimation of shear rate levels. In the drainage zone the non-Newtonian behavior of blood was less relevant. CONCLUSIONS The most proximal holes drained the largest amount of fluid. The flow features and distribution of flow rates among the holes showed little dependence on the hematocrit. The non-Newtonian behavior of blood had a small influence on the dynamics of the flow.
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Affiliation(s)
- Francesco Fiusco
- FLOW, Department of Engineering Mechanics, KTH, Stockholm, Sweden
| | - Federico Rorro
- FLOW, Department of Engineering Mechanics, KTH, Stockholm, Sweden
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Russ M, Steiner E, Boemke W, Busch T, Melzer-Gartzke C, Taher M, Badulak J, Weber-Carstens S, Swenson ER, Francis RC, Pickerodt PA. Extracorporeal Membrane Oxygenation Blood Flow and Blood Recirculation Compromise Thermodilution-Based Measurements of Cardiac Output. ASAIO J 2022; 68:721-729. [PMID: 34860710 PMCID: PMC9067097 DOI: 10.1097/mat.0000000000001592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The contribution of veno-venous (VV) extracorporeal membrane oxygenation (ECMO) to systemic oxygen delivery is determined by the ratio of total extracorporeal blood flow () to cardiac output (). Thermodilution-based measurements of may be compromised by blood recirculating through the ECMO (recirculation fraction; Rf). We measured the effects of and Rf on classic thermodilution-based measurements of in six anesthetized pigs. An ultrasound flow probe measured total aortic blood flow () at the aortic root. Rf was quantified with the ultrasound dilution technique. was set to 0-125% of and was measured using a pulmonary artery catheter (PAC) in healthy and lung injured animals. PAC overestimated () at all settings compared to . The mean bias between both methods was 2.1 L/min in healthy animals and 2.7 L/min after lung injury. The difference between and increased with an of 75-125%/ compared to QEC <50%/. Overestimation of was highest when resulted in a high Rf. Thus, thermodilution-based measurements can overestimate cardiac output during VV ECMO. The degree of overestimation of depends on the EC/ ratio and the recirculation fraction.
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Affiliation(s)
- Martin Russ
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Elvira Steiner
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Willehad Boemke
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thilo Busch
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Melzer-Gartzke
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mahdi Taher
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jenelle Badulak
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Steffen Weber-Carstens
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, Seattle, Washington
| | - Roland C.E. Francis
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp A. Pickerodt
- From the Department of Anesthesiology and Intensive Care Medicine (CCM, CVK); Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Vatani A, Liao S, Burrell AJC, Carberry J, Azimi M, Steinseifer U, Arens J, Soria J, Pellegrino V, Kaye D, Gregory SD. Improved Drainage Cannula Design to Reduce Thrombosis in Veno-Arterial Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:205-213. [PMID: 33883503 DOI: 10.1097/mat.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Thrombosis is a potentially life-threatening complication in veno-arterial extracorporeal membrane oxygenation (ECMO) circuits, which may originate from the drainage cannula due to unfavorable blood flow dynamics. This study aims to numerically investigate the effect of cannula design parameters on local fluid dynamics, and thus thrombosis potential, within ECMO drainage cannulas. A control cannula based on the geometry of a 17 Fr Medtronic drainage cannula concentrically placed in an idealized, rigid-walled geometry of the right atrium and superior and inferior vena cava was numerically modeled. Simulated flow dynamics in the control cannula were systematically compared with 10 unique cannula designs which incorporated changes to side hole diameter, the spacing between side holes, and side hole angles. Local blood velocities, maximum wall shear stress (WSS), and blood residence time were used to predict the risk of thrombosis. Numerical results were experimentally validated using particle image velocimetry. The control cannula exhibited low blood velocities (59 mm/s) at the cannula tip, which may promote thrombosis. Through a reduction in the side hole diameter (2 mm), the spacing between the side holes (3 mm) and alteration in the side hole angle (30° relative to the flow direction), WSS was reduced by 52%, and cannula tip blood velocity was increased by 560% compared to the control cannula. This study suggests that simple geometrical changes can significantly alter the risk of thrombosis in ECMO drainage cannulas.
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Affiliation(s)
- Ashkan Vatani
- From the Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardio-Respiratory Engineering and Technology Laboratory (CREATELab), Monash University, Clayton, VIC, Australia
| | - Sam Liao
- From the Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardio-Respiratory Engineering and Technology Laboratory (CREATELab), Monash University, Clayton, VIC, Australia
| | - Aidan J C Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Josie Carberry
- From the Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia
| | - Marjan Azimi
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardio-Respiratory Engineering and Technology Laboratory (CREATELab), Monash University, Clayton, VIC, Australia
| | - Ulrich Steinseifer
- From the Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Germany
| | - Jutta Arens
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Germany
- Chair of Engineering Organ Support Technologies, Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands
| | - Julio Soria
- Laboratory for Turbulence Research in Aerospace and Combustion ( LTRAC ), Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Kaye
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- The Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Shaun D Gregory
- From the Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardio-Respiratory Engineering and Technology Laboratory (CREATELab), Monash University, Clayton, VIC, Australia
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Hugenroth K, Neidlin M, Engelmann UM, Kaufmann TAS, Steinseifer U, Heilmann T. Tipless transseptal cannula concept combines improved hemodynamic properties and risk-reduced placement: An in silico proof-of-concept. Artif Organs 2021; 45:1024-1035. [PMID: 33851427 DOI: 10.1111/aor.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
As a leading cause of death worldwide, heart failure is a serious medical condition in which many critically ill patients require temporary mechanical circulatory support (MCS) as a bridge-to-recovery or bridge-to-decision. In many cases, the TandemHeart system is used to unload the left heart by draining blood from the left atrium (LA) to the femoral artery via a transseptal multistage cannula. However, even though the correct positioning of the cannula is crucial for a safe treatment, the long cannula tip currently used in transseptal cannulas complicates positioning, making the cannula vulnerable to displacement during MCS. To overcome these limitations, we propose the development of a new tipless transseptal cannula with improved hemodynamic properties. We discuss the tipless cannula concept by comparing it to the common multistage cannula concept using computational fluid dynamics simulations and assess the flow field in the LA, the wall shear stresses (WSS), and the pressure loss. Across the two distinct time points of end-systole and end-diastole and two drainage flow rates of 3.5 and 5.0 L/min, we find a more homogeneous inlet flow pattern for the tipless cannula concept, accompanied by a remarkably reduced area of platelet-activating WSS (up to 10-times smaller area compared to the multistage cannula). Moreover, pressure loss is up to 14.5% lower in the tipless cannula concept, confirming overall improved hemodynamic properties of the tipless cannula concept. Finally, a diameter-dependent study reveals that lower WSS and pressure losses can be further reduced by large-lumen designs for any simulation setting. Overall, our results suggest that a tipless cannula concept remedies the crucial disadvantages of a long-tip multistage cannula by reducing the risk of misplacement, and it furthermore promotes optimized hemodynamics. With this successful proof-of-concept, we underscore the potential for and encourage the realization of further experimental investigations regarding the development of a tipless transseptal cannula for MCS.
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Affiliation(s)
- Kristin Hugenroth
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,enmodes GmbH, Aachen, Germany
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Ulrich M Engelmann
- enmodes GmbH, Aachen, Germany.,Department of Medical Engineering and Applied Mathematics, FH Aachen University of Applied Sciences, Aachen, Germany
| | - Tim A S Kaufmann
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,enmodes GmbH, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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7
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Rauh P, Benk C, Beyersdorf F, Russe M. Determination of local flow ratios and velocities in a femoral venous cannula with computational fluid dynamics and 4D flow-sensitive magnetic resonance imaging: A method validation. Artif Organs 2020; 45:506-515. [PMID: 33185904 DOI: 10.1111/aor.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/09/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022]
Abstract
Cannulas with multi-staged side holes are the method of choice for femoral cannulation in extracorporeal therapies today. A variety of differently designed products is available on the market. While the preferred tool for the performance assessment of such cannulas are pressure-flow curves, little is known about the flow and velocity distribution. Within this work flow and velocity patterns of a femoral venous cannula with multi-staged side holes were investigated. A mock circulation loop for cannula performance evaluation was built and reproduced using a computer-aided design system. With computational fluid dynamics, volume flows and fluid velocities were determined quantitatively and visually with hole-based precision. In order to ensure the correctness of the flow simulation, the results were subsequently validated by determining the same parameters with four-dimensional flow-sensitive magnetic resonance imaging. Measurement data and numerical solution differed 7% on average throughout the data set for the examined parameters. The highest inflow and velocity were detected at the most proximal holes, where half of the total volume flow enters the cannula. At every hole stage a Y-shaped inflow profile was detected, forming a centered stream in the middle of the cannula. Simultaneously, flow separation creates zones with significant lower flow velocities. Numerical simulation, validated with four-dimensional flow-sensitive magnetic resonance imaging, is a valuable tool to examine flow and velocity distributions of femoral venous cannulas with hole-based accuracy. Flow and velocity distribution in such cannulas are not ideal. Based on this work future cannulas can be effectively optimized.
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Affiliation(s)
- Patrick Rauh
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Research & Development, Xenios AG, Heilbronn, Germany
| | - Christoph Benk
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany
| | - Maximilian Russe
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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8
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Goto T, Tanabe T, Inamura T, Shirota M, Fumoto K, Saito Y, Fukuda W, Fukuda I, Daitoku K, Minakawa M. Effect of inflow cannula side-hole number on drainage flow characteristics: flow dynamic analysis using numerical simulation. Perfusion 2018; 33:649-655. [DOI: 10.1177/0267659118782246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Venous drainage in cardiopulmonary bypass is a very important factor for safe cardiac surgery. However, the ideal shape of venous drainage cannula has not been determined. In the present study, we evaluated the effect of side-hole number under fixed total area and venous drainage flow to elucidate the effect of increasing the side-hole numbers. Method: Computed simulation of venous drainage was performed. Cannulas were divided into six models: an end-hole model (EH) and models containing four (4SH), six (6SH), eight (8SH), 10 (10SH) or 12 side-holes (12SH). Total orifice area of the side-holes was fixed to 120 mm2 on each side-hole cannula. The end-hole orifice area was 36.3 mm2. The total area of the side-holes was kept constant when the number of side-holes was increased. Result: The mean venous drainage flow rate of the EH, 4SH, 6SH, 8SH, 10SH and 12SH was 2.57, 2.52, 2.51, 2.50, 2.49, 2.41 L/min, respectively. The mean flow rate decreased in accordance with the increased number of side-holes. Conclusion: We speculate that flow separation at the most proximal site of the side-hole induces stagnation of flow and induces energy loss. This flow separation may hamper the main stream from the end-hole inlet, which is most effective with low shear stress. The EH cannula was associated with the best flow rate and flow profile. However, by increasing side-hole numbers, flow separation occurs on each side-hole, resulting in more energy loss than the EH cannula and flow rate reduction.
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Affiliation(s)
- Takeshi Goto
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tsubasa Tanabe
- Department of Intelligent Machines and System Engineering, Faculty of Science and Technology, Hirosaki University, Hirosaki, Japan
| | - Takao Inamura
- Department of Intelligent Machines and System Engineering, Faculty of Science and Technology, Hirosaki University, Hirosaki, Japan
| | - Minori Shirota
- Department of Intelligent Machines and System Engineering, Faculty of Science and Technology, Hirosaki University, Hirosaki, Japan
| | - Koji Fumoto
- Department of Mechanical Engineering, College of Science and Engineering, Aoyama Gakuin University, Kanagawa, Japan
| | - Yoshiaki Saito
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Wakako Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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9
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A Simple, Standard Method to Characterize Pressure/Flow Performance of Vascular Access Cannulas. ASAIO J 2013. [DOI: 10.1097/mat.0b013e3182746401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Abstract
This paper reviews the basic fluid dynamics underlying extracorporeal membrane oxygenation (ECMO) cannula design. General cannula features and their effect on flow are discussed and the specific requirements of different ECMO circuits are explained. The current commercially available cannula options for veno-arterial and veno-venous circuits are reviewed and the main characteristics presented.
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Affiliation(s)
- K Kohler
- Department of Anaesthesia, West Suffolk Hospital, Bury St Edmunds, UK
| | - K Valchanov
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - G Nias
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - A Vuylsteke
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Papworth Everard, Cambridgeshire, UK
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