Influence of Cannulation Site on Carotid Perfusion During Extracorporeal Membrane Oxygenation in a Compliant Human Aortic Model
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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.
KeywordsExtracorporeal circulation Circulatory support Mock circulation Intraaortic balloon pump Surplus hemodynamic energy
Extracorporeal membrane oxygenation
Energy equivalent pressure
Intraaortic balloon pump
Left common carotid artery
Right common carotid artery
Surplus hemodynamic energy
- VA 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.
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)
- 2.Belohlavek, J., M. Mlček, M. Huptych, T. Svoboda, S. Havránek, P. Ošt’ádal, T. Bouček, T. Kovárník, F. Mlejnský, V. Mrázek, M. Bělohlávek, M. Aschermann, A. Linhart, and O. Kittnar. Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation. Crit. Care 16:R50, 2012.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Cheng, R., R. Hachamovitch, M. Kittleson, J. Patel, F. Arabia, J. Moriguchi, F. Esmailian, and B. Azarbal. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann. Thorac. Surg. 97:610–616, 2014.CrossRefPubMedGoogle Scholar
- 5.den Hartog, A. W., R. Franken, P. de Witte, T. Radonic, H. A. Marquering, W. E. van der Steen, J. Timmermans, A. J. Scholte, M. P. van den Berg, A. H. Zwinderman, B. J. M. Mulder, and M. Groenink. Aortic disease in patients with Marfan syndrome: aortic volume assessment for surveillance. Radiology 269:370–377, 2013.CrossRefGoogle Scholar
- 7.Extracorporeal Life Support Organization. ELSO guidelines. http://www.elso.org/Resources/Guidelines.aspx. Retrieved 18 May 2017.
- 21.Pfluecke, C., M. Christoph, S. Kolschmann, D. Tarnowski, M. Forkmann, S. Jellinghaus, D. M. Poitz, C. Wunderlich, R. H. Strasser, S. Schoen, and K. Ibrahim. Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function. Perfusion. 29:511–516, 2014.CrossRefPubMedGoogle Scholar
- 22.R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/, 2014.