| 1. |
- Fiusco, Francesco, 1994-, et al.
(författare)
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Sensitivity of hemolysis modelling in a tiltedlighthouse tip cannula
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Extracorporeal membrane oxygenation is a life-saving treatment used insevere cardiac/lung failure. The occurrence of non-physiological stresses and thepresence of artificial surfaces gives rise to complications as thrombus formationand hemolysis. While CFD can be a powerful tool to assess risks associatedto mechanical stresses, the use of models to compute blood flow and predictblood damage entails uncertainties on the results that need to be quantified. Inthis work, the geometry of a ECMO return cannula in a shifted position wasused as a benchmark to evaluate the effects of model coefficients for hemolysiscomputation and the effect of different types of viscosity modelling at differenthematocrits. The results showed that the largest uncertainty was induced bythe chosen model coefficients, with variability of up to two orders of magnitude.Using a Newtonian analog led to similar global hemolysis indices compared toa non-Newtonian model, if the viscosity value was based on the asymptoticviscosity of the non-Newtonian model. Considering the local values of hemolysis,differences were observed in stagnation areas, with variations of more than 50%.The inclusion of a simple red blood cell transport model did not significantlyaffect time-averaged results, but it introduced larger time variability.
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| 2. |
- Fiusco, Francesco, 1994-, et al.
(författare)
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Blood pumps for extracorporeal membrane oxygenation : Platelet activation during different operating conditions
- 2021
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Ingår i: ASAIO journal (1992). - : Ovid Technologies (Wolters Kluwer Health). - 1058-2916 .- 1538-943X. ; Publish Ahead of Print
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Tidskriftsartikel (refereegranskat)abstract
- Extracorporeal membrane oxygenation (ECMO) is a therapy used in severe cardiopulmonary failure. Blood is pumped through an artificial circuit exposing it to nonphysiologic conditions, which promote platelet activation and coagulation. Centrifugal pumps used at lower flow rates than their design point may lose pump efficiency and increase the risk of hemolysis. In this study, thrombogenic properties of two ECMO pumps designed for adult and neonatal use were evaluated using simulations in different flow scenarios. Three scenarios, adult pump in adult mode (4 L/min), adult pump in baby mode (300 ml/min), and neonatal pump used in its design point (300 ml/min), were simulated using computational fluid dynamics. The flow was numerically seeded with platelets, whose activation state was computed considering the stress history that acted along their respective path lines. Statistical distributions of activation state and residence time were drawn. The results showed that using the adult pump in baby mode increased the fraction of platelets with higher activation state confirming that low-pump flow rate impacts thrombogenicity. The neonatal pump showed a backflow at the inlet, which carried platelets in a retrograde motion contributing to an increased thrombogenic potential compared with the adult mode scenario.
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| 3. |
- Fiusco, Francesco, 1994-
(författare)
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Computational modelling of blood flow in medical assist devices
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extracorporeal membrane oxygenation (ECMO) is a life-saving support treat-ment in case of pulmonary and/or cardiac failure. An artificial extracorporealcircuit is used to offload the function of lungs and/or heart. Patient blood is drained through a drainage cannula, pumped with a centrifugal pump, oxygenated in a membrane lung and returned to the body through a reinfusion cannula. Tubing and connectors complete the circuit. However, its use canlead to thromboembolic and haemolytic complications, which are related to mechanical stresses arising in the flow of blood through its components. Numerical simulations of some of the pumps and cannulae used in the circuit were performed to investigate the flow structures developing in these components and their relation to measures of blood damage in the form of platelet activation state (PAS) and haemolysis index (HI). Simulations of two magnetically levitated centrifugal ECMO pumps were performed both in on- and off-label conditions with flow rates compatible with adult and neonatal use. The results showed that off-label low flow rate can be damaging due to an increase of residence time of the particles, which exposed them for longer to non-physiological stress. This held true for both passive tracers and inertial particles subjected to lift and drag. The neonatal pump showed a backflow structure with flow swirling back to the inlet tubing over its whole labelled range. Simulations of a lighthouse drainage cannula were undertaken to assess drainage characteristics at different haematocrits and flow rate ratios. The results indicated that the flow field was dominated by a jet in crossflow type of structure, with the most proximal holes draining the largest amount of fluid in all the studied cases and for all the considered haematocrits. The effects due to non-Newtonian behaviour of blood were less relevant in the drainage area, allowing to use a Reynolds number analogy to bridge between water and blood results.A lighthouse cannula in return configuration was also considered in both a centred and a tilted position. A characteristic confined jet configuration was found, with a backflow developing at the vessel wall, increasing residence time. In the tilted case, a group of small vortical structures developed at the holes close to the wall, which behaved as an obstacle to the vessel flow and increased both residence time and stress. This led to locally increased haemolysis which, however, did not impact haemolysis at large due to the low flow exposed to this area. The use of different viscosity models in this case led to small variations in the results, which were minor compared to the uncertainty introduced by the use of different model coefficients in the computation of the haemolysis index.
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| 4. |
- Fiusco, Francesco, 1994-, et al.
(författare)
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Effect of low rate ratio and positioning on a lighthouse tip ECMO return cannula
- 2023
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Ingår i: Biomechanics and Modeling in Mechanobiology. - 1617-7959 .- 1617-7940.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Extracorporeal membrane oxygenation is a life-saving support therapy in the case of cardiopulmonary refractory failure. Its use is associated to complications due to the presence of artificial surfaces and supraphysiological stress conditions. Thus, knowledge of the fluid structures associated to each component can give insight into sources of blood damage. In this study, an experimentally validated numerical study of a conventional lighthouse tip cannula in return configuration was carried out to characterize the flow structures using water or a Newtonian blood analog with different flow rate ratios and cannula positioning and their influence on hemolysis. The results showed that strong shear layers developed where the jets from the side holes met the co-flow. Stationary backflow regions at the vessel wall were also present downstream of the cannula. In the tilted case, the recirculation was much more pronounced on the wide side and almost absent on the narrow side. Small vortical backflow structures developed at the side holes which behaved like obstacles to the co-flow, creating pairs of counter-rotating vortices, which induced locally higher risk of hemolysis. However, global hemolysis index did not show significant deviations. Across the examined flow rate ratios, the holes on the narrow side consistently reinfused a larger fraction of fluid. A radial force developed in the tilted case in a direction so as to recenter the cannula in the vessel.
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| 5. |
- Fiusco, Francesco, 1994-
(författare)
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Hemodynamics of artificial devices used in extracorporeal life support
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extracorporeal Membrane Oxygenation (ECMO) is a life-saving therapy usedfor support in critical heart and/or lung failure. Patient’s blood is pumped viaan artificial lung for oxygenation outside of the body. The circuit is composedof a blood pump, cannulae for drainage and reinfusion, a membrane lung,tubing and connectors. Its use is associated with thromboembolic complicationsand hemolytic damage. Detailed numerical studies of two blood pumps anda lighthouse tip drainage cannula were undertaken to characterize the flowstructures in different scenarios and their link to platelet activation. The pumpsimulations were modelled according to manufacturer’s proclaimed use but alsoin off-design conditions with flow rates used in adult and neonatal patients.Lagrangian Particle Tracking (LPT) was used to simulate the injection ofparticles similar in size to platelets to compute platelet activation state (PAS).The results indicated that low flow rates impacted PAS similarly to high flowrates due to increased residence time leading to prolonged exposure to shearstress despite the fact that shear per se was lower at low flow rate. Regardingthe cannula, the results showed that a flow pattern similar to a jet in crossflowdeveloped at the side holes. A parameter study was conducted to quantifydrainage characteristics in terms of flow rate distribution across the holes wheninput variables of flow rate, modelled fluid, and hematocrit were altered. Thefindings showed, across all the cases, that the most proximal hole row drainedthe largest fraction of fluid. The effects due to the non-Newtonian nature ofblood were confined to regions far from the cannula holes and the flow structuresshowed very limited dependence on the hematocrit. A scaling law was found tobridge the global drainage performance of fluid between water and blood.
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| 6. |
- Fiusco, Francesco, 1994-, et al.
(författare)
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Numerical and experimental investigation of a lighthouse tip drainage cannula used in extracorporeal membrane oxygenation
- 2023
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Ingår i: Artificial Organs. - : Wiley. - 0160-564X .- 1525-1594. ; 47:2, s. 330-341
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Tidskriftsartikel (refereegranskat)abstract
- 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. An investigation of the flow structures developing in a conventional 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. The results indicated that the 90◦ bends of the flow through the side holes created a recirculation zone potentially increasing the residence time and flow structures developing inside the cannula resembling a jet in a crossflow. The use of different hematocrits did not induce a considerable effect on the drainage performance, with the most proximal set of holes from the tip draining 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, and a Reynolds-number scaling was applied to capture the velocity profiles and flow rates through the side holes.
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| 7. |
- Parker, Louis P., et al.
(författare)
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Venovenous extracorporeal membrane oxygenation drainage cannula performance : From generalized to patient-averaged vessel model
- 2024
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Ingår i: Physics of fluids. - : AIP Publishing. - 1070-6631 .- 1089-7666. ; 36:6
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Tidskriftsartikel (refereegranskat)abstract
- Venovenous extracorporeal membrane oxygenation is used for respiratory support in the most severe cases of acute respiratory distress syndrome. Blood is drained from the large veins, oxygenated in an artificial lung, and returned to the right atrium (RA). In this study, we have used large eddy simulations to simulate a single-stage “lighthouse” drainage cannula in a patient-averaged model of the large veins and RA, including the return cannula. We compared the results with previous experimental and numerical studies of these cannulas in idealized tube geometries. According to the simulations, wall proximity at the drainage holes and the presence of the return cannula greatly increased drainage through the tip (33% at 5 L/min). We then simulated a multi-stage device in the same patient-averaged model, showing similar recirculation performance across the range of extracorporeal membrane oxygenation (ECMO) flow rates compared to the lighthouse cannula. Mean and maximum time-averaged wall shear stress were slightly higher for the lighthouse design. At high ECMO flow rates, the multi-stage device developed a negative caval pressure, which may be a cause of drainage obstruction in a clinical environment. Finally, through calculation of the energy spectra and vorticity field, we observed ring-like vortices inside the cannula originating from the side holes, most prominent in the proximal position. Our work highlights the important differences between a patient-derived and simplified venous model, with the latter tending to underestimate tip drainage. We also draw attention to the different dynamics of single-stage and multistage drainage cannulas, which may guide clinical use.
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| 8. |
- Rorro, Federico, 1993-, et al.
(författare)
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Backflow at the inlet of centrifugal blood pumps enhanced by geometrical features
- 2024
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Ingår i: Physics of fluids. - : AIP Publishing. - 1070-6631 .- 1089-7666. ; 36:3
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Tidskriftsartikel (refereegranskat)abstract
- Extracorporeal life support (ECLS) includes life-saving support in severe acute cardiac and/or pulmonary failure. In the past 20 years, centrifugal pumps have become the primary choice to deliver the required blood flow. Pumps of various designs, with different approved operating ranges, are today available to clinicians. The use of centrifugal pumps in the low flow condition has been shown to increase hemolytic and thrombogenic risks of the treatment. Further, low flow operation has been associated with retrograde flow at the pump inlet. In this study, experimental and numerical methods have been applied to investigate the operating conditions and fluid dynamical mechanisms leading to reverse flow (or backflow) at the inlet. Reverse flow was predominantly observed in pumps having a top shroud covering the impeller blades, showing a relation between pump geometry and backflow. The shroud divides the pump volume above the impeller into two regions, separating the swirling reverse flow migrating toward the upper pump volute from the main flow, reducing the dissipation of the vortical structures, and allowing the swirling reverse flow to reach further in the pump inlet. At the inlet, backflow was observed as stable recirculation areas at the side of the pump inlet.
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| 9. |
- Rorro, Federico, 1993-, et al.
(författare)
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Backflow at the inlet of centrifugal pumps forextracorporeal life support in low flowconditions
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Extracorporeal life support (ECLS) are life-saving therapies used to supportcardiac and pulmonary functions in severe failure. In recent years the use ofcentrifugal pumps to drive the flow has become increasingly common. Severaldesigns are available on the market with different certified operating ranges.The use of centrifugal pumps in low flow conditions has been shown to increasehaemolytic and thrombogenic risks and been linked to the appearance of aretrograde flow at the inlet pipe. In this study, an experimental investigation ofseveral pump designs has been performed to assess the occurrence of backflowacross different operating conditions. Numerical simulations have been carriedout for a geometry and flow case showing backflow to highlight flow structuresassociated to it. The results showed that covered pumps were more likely toexhibit backflow in low flow conditions. The appearance of backflow was linkedto the development of vortical structures rising from the impeller blade tip andrising, being trapped between the shroud and the pump housing.
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