Cannulation configuration and recirculation in venovenous extracorporeal membrane oxygenation

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Parker, Louis P.KTH,Linné Flow Center, FLOW,Teknisk mekanik (author)

Cannulation configuration and recirculation in venovenous extracorporeal membrane oxygenation

Article/chapterEnglish2022

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2022-09-30
Springer Nature,2022
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LIBRIS-ID:oai:DiVA.org:kth-320508
https://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-320508URI
https://doi.org/10.1038/s41598-022-20690-xDOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:150911822URI

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Language:English
Summary in:English

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QC 20221024
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 (author)
Brismar, Torkel B.Karolinska Institutet (author)
Broman, Lars MikaelKarolinska Univ Hosp, ECMO Ctr Karolinska, Pediat Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden. (author)
Prahl Wittberg, Lisa,Docent,1978-KTH,Linné Flow Center, FLOW,Teknisk mekanik(Swepub:kth)u1r2nb1w (author)
KTHLinné Flow Center, FLOW (creator_code:org_t)

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In:Scientific Reports: Springer Nature12:12045-2322

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