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Title
The effect of arterial cannula tip position on differential hypoxemia during venoarterial extracorporeal membrane oxygenation.
Publication Date
2023-03
Author(s)
Wickramarachchi, Avishka
Burrell, Aidan J C
Stephens, Andrew F
Šeman, Michael
Vatani, Ashkan
Khamooshi, Mehrdad
Raman, Jaishankar
Bellomo, Rinaldo
Gregory, Shaun D
Subject
Cannula position
Computational fluid dynamics
Harlequin syndrome
Mixing zone
North–south syndrome
Watershed region
Type of document
Journal Article
OrcId
0000-0003-2623-7009
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DOI
10.1007/s13246-022-01203-6
Abstract
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.
Link
Citation
Physical and Engineering Sciences in Medicine 2023; 46(1)
Jornal Title
Physical and Engineering Sciences in Medicine
ISSN
2662-4737

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