Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30229
Title: Hemodynamics of small arterial return cannulae for venoarterial extracorporeal membrane oxygenation.
Austin Authors: Stephens, Andrew F;Wickramarachchi, Avishka;Burrell, Aidan J C;Bellomo, Rinaldo ;Raman, Jaishankar;Gregory, Shaun D
Affiliation: Intensive Care..
Surgery (University of Melbourne)..
Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Victoria, Australia..
Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia..
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia..
Cardiothoracic Surgery, University of Melbourne, Melbourne, Victoria, Australia..
Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia..
Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia..
Cardiothoracic Surgery, St Vincent's Hospitals, Melbourne, Victoria, Australia..
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia..
Issue Date: Jun-2022
Date: 2022-02-03
Publication information: Artificial organs 2022; 46(6): 1068-1076
Abstract: Venoarterial extracorporeal membrane oxygenation (ECMO) provides mechanical support for critically ill patients with cardiogenic shock. Typically, the size of the arterial return cannula is chosen to maximize flow. However, smaller arterial cannulae may reduce cannula-related complications and be easier to insert. This in vitro study quantified the hemodynamic effect of different arterial return cannula sizes in a simulated acute heart failure patient. Baseline support levels were simulated with a 17 Fr arterial cannula in an ECMO circuit attached to a cardiovascular simulator with targeted partial (2.0 L/min ECMO flow, 60-65 mm Hg mean aortic pressure-MAP) and targeted full ECMO support (3.5 L/min ECMO flow and 70-75 mm Hg MAP). Return cannula size was varied (13-21 Fr), and hemodynamics were recorded while keeping ECMO pump speed constant and adjusting pump speed to restore desired support levels. Minimal differences in hemodynamics were found between cannula sizes in partial support mode. A maximum pump speed change of +600 rpm was required to reach the support target, and arterial cannula inlet pressure varied from 79 (21 Fr) to 224 mm Hg (13 Fr). The 15 Fr arterial cannula could provide the target full ECMO support at the targeted hemodynamics; however, the 13 Fr cannula could not due to the high resistance associated with the small diameter. A 15 Fr arterial return cannula provided targeted partial and full ECMO support to a simulated acute heart failure patient. Balancing reduced cannula size and ECMO support level may improve patient outcomes by reducing cannula-related adverse events.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30229
DOI: 10.1111/aor.14179
ORCID: 0000-0002-2271-750X
0000-0003-2623-7009
0000-0001-8430-9678
0000-0002-5448-1917
0000-0002-1650-8939
0000-0002-7691-4779
Journal: Artificial organs
PubMed URL: 35049072
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35049072/
Type: Journal Article
Subjects: ECMO
ECPR
arterial cannula
bleeding
ischemia
out of hospital cannulation
return cannula
vascular injury
Appears in Collections:Journal articles

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