TY - JOUR
T1 - The effect of arterial cannula tip position on differential hypoxemia during venoarterial extracorporeal membrane oxygenation
AU - Wickramarachchi, Avishka
AU - Burrell, Aidan J.C.
AU - Stephens, Andrew F.
AU - Šeman, Michael
AU - Vatani, Ashkan
AU - Khamooshi, Mehrdad
AU - Raman, Jaishankar
AU - Bellomo, Rinaldo
AU - Gregory, Shaun D.
N1 - Funding Information:
This work was supported by Monash University. Shaun D Gregory is the recipient of a Fellowship (102062) from the National Heart Foundation of Australia.
Publisher Copyright:
© 2022, Australasian College of Physical Scientists and Engineers in Medicine.
PY - 2023/3
Y1 - 2023/3
N2 - Interaction between native ventricular output and venoarterial extracorporeal membrane oxygenation (VA ECMO) flow may hinder oxygenated blood flow to the aortic arch branches, resulting in differential hypoxemia. Typically, the arterial cannula tip is placed in the iliac artery or abdominal aorta. However, the hemodynamics of a more proximal arterial cannula tip have not been studied before. This study investigated the effect of arterial cannula tip position on VA ECMO blood flow to the upper extremities using computational fluid dynamics simulations. Four arterial cannula tip positions (P1. common iliac, P2. abdominal aorta, P3. descending aorta and P4. aortic arch) were compared with different degrees of cardiac dysfunction and VA ECMO support (50%, 80% and 90% support). P4 was able to supply oxygenated blood to the arch vessels at all support levels, while P1 to P3 only supplied the arch vessels during the highest level (90%) of VA ECMO support. Even during the highest level of support, P1 to P3 could only provide oxygenated VA-ECMO flow at 0.11 L/min to the brachiocephalic artery, compared with 0.5 L/min at P4. This study suggests that cerebral perfusion of VA ECMO flow can be increased by advancing the arterial cannula tip towards the aortic arch.
AB - Interaction between native ventricular output and venoarterial extracorporeal membrane oxygenation (VA ECMO) flow may hinder oxygenated blood flow to the aortic arch branches, resulting in differential hypoxemia. Typically, the arterial cannula tip is placed in the iliac artery or abdominal aorta. However, the hemodynamics of a more proximal arterial cannula tip have not been studied before. This study investigated the effect of arterial cannula tip position on VA ECMO blood flow to the upper extremities using computational fluid dynamics simulations. Four arterial cannula tip positions (P1. common iliac, P2. abdominal aorta, P3. descending aorta and P4. aortic arch) were compared with different degrees of cardiac dysfunction and VA ECMO support (50%, 80% and 90% support). P4 was able to supply oxygenated blood to the arch vessels at all support levels, while P1 to P3 only supplied the arch vessels during the highest level (90%) of VA ECMO support. Even during the highest level of support, P1 to P3 could only provide oxygenated VA-ECMO flow at 0.11 L/min to the brachiocephalic artery, compared with 0.5 L/min at P4. This study suggests that cerebral perfusion of VA ECMO flow can be increased by advancing the arterial cannula tip towards the aortic arch.
KW - Cannula position
KW - Computational fluid dynamics
KW - Harlequin syndrome
KW - Mixing zone
KW - North–south syndrome
KW - Watershed region
UR - http://www.scopus.com/inward/record.url?scp=85143236588&partnerID=8YFLogxK
U2 - 10.1007/s13246-022-01203-6
DO - 10.1007/s13246-022-01203-6
M3 - Article
C2 - 36459331
AN - SCOPUS:85143236588
SN - 2662-4729
VL - 46
SP - 119
EP - 129
JO - Physical and Engineering Sciences in Medicine
JF - Physical and Engineering Sciences in Medicine
IS - 1
ER -