Hemodynamic and recirculation performance of dual lumen cannulas for venovenous extracorporeal membrane oxygenationShow others and affiliations
2023 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 13, no 1, article id 7472
Article 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
National Category
Health Sciences
Identifiers
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
Note
QC 20230713
2023-07-132023-07-132023-07-13Bibliographically approved