Annals of Biomedical Engineering

, Volume 45, Issue 10, pp 2281–2297 | Cite as

Influence of Cannulation Site on Carotid Perfusion During Extracorporeal Membrane Oxygenation in a Compliant Human Aortic Model

  • Andreas Geier
  • Andreas Kunert
  • Günter Albrecht
  • Andreas Liebold
  • Markus HoenickaEmail author


Blood oxygenized by veno-arterial extracorporeal membrane oxygenation (ECMO) can be returned to the aorta (central cannulation) or to peripheral arteries (axillar, femoral). Hemodynamic effects of these cannulation types were analyzed in a mock loop with an aortic model representative of normal anatomy and compliance under physiological pressures and flow rates. Pressures, flow rates, and contribution of ECMO flow to total flow as a measure of oxygen supply were monitored in the carotids. Steady or pulsatile ECMO flow, residual or no cardiac output, and intraaortic balloon pump counterpulsation were tested as independent factors. With residual heart function, central cannulation provided the best oxygenated flow and pressure to the carotid arteries (CA). Axillar cannulation preferentially perfused the right CA at the expense of the left CA. Femoral cannulation provided only lower amounts of oxygenated blood to both CA. Pulsation increased the surplus hemodynamic energy. Counterpulsation reduced flow with femoral cannulation but improved flow and pressure with axillar cannulation. Femoral cannulation failed to provide oxygenated blood to coronary and supraaortic arteries with residual heart function. Central cannulation provided the best hemodynamics and oxygen supply to the brain. With a resting heart but not with an ejecting heart, pulsatile ECMO flow enhanced CA hemodynamics.


Extracorporeal circulation Circulatory support Mock circulation Intraaortic balloon pump Surplus hemodynamic energy 



Carotid arteries


Extracorporeal membrane oxygenation


Energy equivalent pressure


Intraaortic balloon pump


Left common carotid artery


Right common carotid artery


Surplus hemodynamic energy


Veno-arterial ECMO


Ventricular assist device



The authors wish to thank Tobias Böckers, Ulrich Fassnacht, and Ernst Voigt (Department of Anatomy and Cell Biology, University of Ulm, Germany) as well as Hagen Gorki (Department of Cardiothoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany) for their permission for and support in creating the aortic wax cast from a body donor. The help of the students Jakub Fusiak and Sarah Math was indispensable for assembling the mock loop and for writing its data acquisition software. This study was generously supported by Medos (Heilbronn, Germany) who provided the VAD and ECMO systems for the duration of this study as well as funds that partially covered the costs of the mock loop components.

Conflict of interest

The authors declare that there are no conflicts of interest.

Supplementary material

This short movie clip shows the aortic model during pulsatile flow generated by the ventricular assist device which serves as the left ventricle of the mock loop. The flow rate is 4.1 L/min at 65 beats per minute, a mean arterial pressure of approx. 105 mmHg, and a pulse amplitude of approx. 50 mmHg (MP4 6047 kb)

10439_2017_1875_MOESM2_ESM.pdf (5.9 mb)
Flow and pressure waveforms in the right common carotid artery. All graphs use the same scaling. The abscissa shows the time (0–10 s). The ordinates show the flow (black, 0.15–0.52 mL/min) and the pressure (red, 45–260 mmHg) in the right common carotid artery of the model (PDF 5994 kb)


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Copyright information

© Biomedical Engineering Society 2017

Authors and Affiliations

  1. 1.Department of Cardiothoracic and Vascular SurgeryUniversity of Ulm Medical CenterUlmGermany

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