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Wickramarachchi A, Burrell AJC, Stephens AF, Šeman M, Vatani A, Khamooshi M, Raman J, Bellomo R, Gregory SD. The effect of arterial cannula tip position on differential hypoxemia during venoarterial extracorporeal membrane oxygenation. Phys Eng Sci Med 2023; 46:119-129. [PMID: 36459331 DOI: 10.1007/s13246-022-01203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
Interaction between native ventricular output and venoarterial extracorporeal membrane oxygenation (VA ECMO) flow may hinder oxygenated blood flow to the aortic arch branches, resulting in differential hypoxemia. Typically, the arterial cannula tip is placed in the iliac artery or abdominal aorta. However, the hemodynamics of a more proximal arterial cannula tip have not been studied before. This study investigated the effect of arterial cannula tip position on VA ECMO blood flow to the upper extremities using computational fluid dynamics simulations. Four arterial cannula tip positions (P1. common iliac, P2. abdominal aorta, P3. descending aorta and P4. aortic arch) were compared with different degrees of cardiac dysfunction and VA ECMO support (50%, 80% and 90% support). P4 was able to supply oxygenated blood to the arch vessels at all support levels, while P1 to P3 only supplied the arch vessels during the highest level (90%) of VA ECMO support. Even during the highest level of support, P1 to P3 could only provide oxygenated VA-ECMO flow at 0.11 L/min to the brachiocephalic artery, compared with 0.5 L/min at P4. This study suggests that cerebral perfusion of VA ECMO flow can be increased by advancing the arterial cannula tip towards the aortic arch.
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Affiliation(s)
- Avishka Wickramarachchi
- Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia.
| | - Aidan J C Burrell
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew F Stephens
- Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | - Michael Šeman
- Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Ashkan Vatani
- Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | - Jaishankar Raman
- Cardiothoracic Surgery, Austin & St Vincent's Hospitals, University of Melbourne, Melbourne, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Intensive Care Unit, Austin Hospital, Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Shaun D Gregory
- Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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