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Hemodynamic and recirculation performance of dual lumen cannulas for venovenous extracorporeal membrane oxygenation
KTH, School of Engineering Sciences (SCI), Engineering Mechanics, Fluid Mechanics and Engineering Acoustics.ORCID iD: 0000-0002-5409-8280
Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 7472Article in journal (Refereed) Published
Abstract [en]

Venovenous extracorporeal membrane oxygenation (ECMO) can be performed with two single lumen cannulas (SLCs) or one dual-lumen cannula (DLC) where low recirculation fraction (Rf) is a key performance criterion. DLCs are widely believed to have lower Rf , though these have not been directly compared. Similarly, correct positioning is considered critical although its impact is unclear. We aimed to compare two common bi-caval DLC designs and quantify R f in several positions. Two different commercially available DLCs were sectioned, measured, reconstructed, scaled to 27Fr and simulated in our previously published patient-averaged computational model of the right atrium (RA) and venae cavae at 2–6 L/min. One DLC was then used to simulate ± 30° and ± 60° rotation and ± 4 cm insertion depth. Both designs had low Rf (< 7%) and similar SVC/IVC drainage fractions and pressure drops. Both cannula reinfusion ports created a high-velocity jet and high shear stresses in the cannula (> 413 Pa) and RA (> 52 Pa) even at low flow rates. Caval pressures were abnormally high (16.2–23.9 mmHg) at low flow rates. Rotation did not significantly impact Rf . Short insertion depth increased Rf (> 31%) for all flow rates whilst long insertion only increased Rf at 6 L/min (24%). Our results show that DLCs have lower Rf compared to SLCs at moderate-high flow rates (> 4 L/min), but high shear stresses. Obstruction from DLCs increases caval pressures at low flow rates, a potential reason for increased intracranial hemorrhages. Cannula rotation does not impact Rf though correct insertion depth is critical.

Place, publisher, year, edition, pages
Springer Nature , 2023. Vol. 13, no 1, article id 7472
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Health Sciences
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URN: urn:nbn:se:kth:diva-331587DOI: 10.1038/s41598-023-34655-1ISI: 001001538500021PubMedID: 37156961Scopus ID: 2-s2.0-85158135461OAI: oai:DiVA.org:kth-331587DiVA, id: diva2:1782276
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QC 20230713

Available from: 2023-07-13 Created: 2023-07-13 Last updated: 2023-07-13Bibliographically approved

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Parker, Louis P.Prahl Wittberg, Lisa

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