Author:
Parker Louis P.,Marcial Anders Svensson,Brismar Torkel B.,Broman Lars Mikael,Prahl Wittberg Lisa
Abstract
AbstractVenovenous 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.
Funder
Region Stockholm
Royal Institute of Technology
Publisher
Springer Science and Business Media LLC
Reference27 articles.
1. Barbaro, R. P. et al. Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the extracorporeal life support organization registry. The Lancet 396(10257), 1071–1078 (2020).
2. Rich, P. B. et al. A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenous extracorporeal life support. J Thorac Cardiovasc Surg 116(4), 628–632 (1998).
3. Identification and management of recirculation in venovenous ECMO. In: Ann Arbor, MI, USA: Extracorporeal Life Support Organization (2015).
4. Annich, G. M., Lynch, W. R., MacLaren, G., Wilson, J. M. & Bartlett, R.H. Ecmo: Extracorporeal cardiopulmonary support in critical care. (2018).
5. Ling, S. K. H. Comparison of atrio-femoral and femoro-atrial venovenous extracorporeal membrane oxygenation in adult. Perfusion 37(1), 14–18 (2022).
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献