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Cannulation configu...
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Parker, Louis P.KTH,Linné Flow Center, FLOW,Teknisk mekanik
(författare)
Cannulation configuration and recirculation in venovenous extracorporeal membrane oxygenation
- Artikel/kapitelEngelska2022
Förlag, utgivningsår, omfång ...
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2022-09-30
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Springer Nature,2022
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printrdacarrier
Nummerbeteckningar
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LIBRIS-ID:oai:DiVA.org:kth-320508
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https://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-320508URI
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https://doi.org/10.1038/s41598-022-20690-xDOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:150911822URI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:art swepub-publicationtype
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QC 20221024
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Venovenous extracorporeal membrane oxygenation is a treatment for acute respiratory distress syndrome. Femoro-atrial cannulation means blood is drained from the inferior vena cava and returned to the superior vena cava; the opposite is termed atrio-femoral. Clinical data comparing these two methods is scarce and conflicting. Using computational fluid dynamics, we aim to compare atrio-femoral and femoro-atrial cannulation to assess the impact on recirculation fraction, under ideal conditions and several clinical scenarios. Using a patient-averaged model of the venae cavae and right atrium, commercially-available cannulae were positioned in each configuration. Additionally, occlusion of the femoro-atrial drainage cannula side-holes with/without reduced inferior vena cava inflow (0-75%) and retraction of the atrio-femoral drainage cannula were modelled. Large-eddy simulations were run for 2-6L/min circuit flow, obtaining time-averaged flow data. The model showed good agreement with clinical atrio-femoral recirculation data. Under ideal conditions, atrio-femoral yielded 13.5% higher recirculation than femoro-atrial across all circuit flow rates. Atrio-femoral right atrium flow patterns resembled normal physiology with a single large vortex. Femoro-atrial cannulation resulted in multiple vortices and increased turbulent kinetic energy at > 3L/min circuit flow. Occluding femoro-atrial drainage cannula side-holes and reducing inferior vena cava inflow increased mean recirculation by 11% and 32%, respectively. Retracting the atrio-femoral drainage cannula did not affect recirculation. These results suggest that, depending on drainage issues, either atrio-femoral or femoro-atrial cannulation may be preferrable. Rather than cannula tip proximity, the supply of available venous blood at the drainage site appears to be the strongest factor affecting recirculation.
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Marcial, Anders SvenssonKarolinska Institutet
(författare)
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Brismar, Torkel B.Karolinska Institutet
(författare)
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Broman, Lars MikaelKarolinska Univ Hosp, ECMO Ctr Karolinska, Pediat Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.
(författare)
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Prahl Wittberg, Lisa,Docent,1978-KTH,Linné Flow Center, FLOW,Teknisk mekanik(Swepub:kth)u1r2nb1w
(författare)
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KTHLinné Flow Center, FLOW
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:Scientific Reports: Springer Nature12:12045-2322
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