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Cannulation configu...
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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
Publisher, publication year, extent ...
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2022-09-30
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Springer Nature,2022
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printrdacarrier
Numbers
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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
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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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.
Subject headings and genre
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Marcial, Anders SvenssonKarolinska Institutet
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Brismar, Torkel B.Karolinska Institutet
(author)
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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.
(author)
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Prahl Wittberg, Lisa,Docent,1978-KTH,Linné Flow Center, FLOW,Teknisk mekanik(Swepub:kth)u1r2nb1w
(author)
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KTHLinné Flow Center, FLOW
(creator_code:org_t)
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In:Scientific Reports: Springer Nature12:12045-2322
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