Analysis of Left Ventricular Unloading by Double Lumen Arterial Cannula During ECMO Assessed by Mathematical Modeling

  • Svitlana StruninaEmail author
  • Jiri Hozman
  • Petr Ostadal
Conference paper
Part of the IFMBE Proceedings book series (IFMBE, volume 68/1)


Extracorporeal membrane oxygenation is increasingly used for the therapy of the cardiogenic shock. However, it has been repeatedly shown that increased afterload associated with extracorporeal membrane oxygenation significantly deteriorates left ventricular performance. A number of approaches suggested how to deal with left ventricular unloading. Each of these methods requires extra interventions, which increase invasiveness of the method and thus does not correspond with current trends in the mini-invasive performance. Therefore, the development of a mini-invasive method of left heart decompression is a significant issue in extracorporeal membrane oxygenation therapy. The study presents an alternative mini-invasive method for the left ventricular unloading during extracorporeal membrane oxygenation. The draft of double lumen arterial cannula for left ventricular unloading during extracorporeal membrane oxygenation was created in AutoCAD software. The Modelica modeling language was used for modeling and simulations. The initial parameter values were derived from measurements on a female swine. Our simulation results indicate that drainage lumen of the presented double lumen arterial cannula for veno-arterial extracorporeal membrane oxygenation is capable of withdrawing 0.374 L/min during extracorporeal blood flow 1 L/min, 0.441 L/min during 2 L/min, 0.481 L/min during 3 L/min, 0.532 L/min during 4 L/min, 0.560 L/min during 5L/min. The double lumen arterial cannula presents an alternative and perspective solution. It is less invasive than the currently used methods for the left ventricle decompression during veno-arterial extracorporeal membrane oxygenation. The double lumen arterial cannula is capable of achieving left ventricle decompression and blood return while requiring only one single puncture.


Extracorporeal membrane oxygenation Double lumen Cannula Left ventricular Decompression 



The authors thank Eva Motyčková from Faculty of Biomedical Engineering, Czech Technical University in Prague and Eva Poncová for help and support.


  1. 1.
    Aissaoui N, Guerot E, Combes A, Delouche A, Chastre J, Leprince P, et al. Two-Dimensional Strain Rate and Doppler Tissue Myocardial Velocities: Analysis by Echocardiography of Hemodynamic and Functional Changes of the Failed Left Ventricle during Different Degrees of Extracorporeal Life Support. Journal of the American Society of Echocardiography;25(6):632–640.Google Scholar
  2. 2.
    Ostadal, Mlcek, Kruger, Hala, Lacko, Mates, et al. Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock. Journal of Translational Medicine 2015 8;13(1).Google Scholar
  3. 3.
    Strunina S, Ostadal P. Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation. Current Research: Cardiology 2016;3(1):5–8.Google Scholar
  4. 4.
    Soleimani, B, and WE Pae. Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock. Perfusion 2012;27(4):326–331.Google Scholar
  5. 5.
    Massetti M, Gaudino M, Crea F. How to transform peripheral extracorporeal membrane oxygenation in the simplest mid-term paracorporeal ventricular assist device. Int J Cardiol 2013;166(3):551–553.Google Scholar
  6. 6.
    Kotani Yasuhiro, Chetan Devin, Rodrigues Warren, Sivarajan V. Ben, Gruenwald Colleen, Anne-Marie Guerguerian, et al. Left Atrial Decompression During Venoarterial Extracorporeal Membrane Oxygenation for Left Ventricular Failure in Children: Current Strategy and Clinical Outcomes. Artificial Organs 2013;37(1):29–36.Google Scholar
  7. 7.
    Fouilloux V, Lebrun L, Macé L, Kreitmann B. Extracorporeal Membranous Oxygenation and Left Atrial Decompression: A Fast and Minimally Invasive Approach. Ann Thorac Surg 2011;91(6):1996–1997.Google Scholar
  8. 8.
    Seib PM, Faulkner Sherry C, CCP, Erickson C. Christopher, Stephen H. Van Devanter, James E. Harrell, et al. Blade and Balloon Atrial Septostomy for Left Heart Decompression in Patients With Severe Ventricular Dysfunction on Extracorporeal Membrane Oxygenation. 1999 Catheter Cardiovasc Interv;46(2):179–186.Google Scholar
  9. 9.
    Kohler K, Valchanov K, Nias G, Vuylsteke A. ECMO cannula review. Perfusion 2013;28(2):114–124.Google Scholar
  10. 10.
    Uggla B, Nilsson TK. Whole blood viscosity in plasma cell dyscrasias. Clin Biochem 2015;48(3):122–124.Google Scholar
  11. 11.
    Hong TH, Byun JH, Yoo BH, Hwang SW, Kim HY, Park JH. Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting. Korean J Thorac Cardiovasc Surg 2015 /06/05;48(3):210–213.Google Scholar
  12. 12.
    Douflé G, Roscoe A, Billia F, Fan E. Echocardiography for adult patients supported with extracorporeal membrane oxygenation. Critical Care 2015;19(1):1–10.Google Scholar
  13. 13.
    Hong, Byun, Yoo, Hwang, Kim, Park. Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting. The Korean Journal of Thoracic and Cardiovascular Surgery 2015 06;48(3):210–213.Google Scholar
  14. 14.
    Kitamura M, Hanzawa K, Takekubo M, Aoki K, Hayashi J. Preclinical Assessment of a Transaortic Venting Catheter for Percutaneous Cardiopulmonary Support. Artificial Organs 2004 March 1;28(3):298–302.Google Scholar
  15. 15.
    Guirgis M, Kumar K, Menkis AH, Freed DH. Minimally invasive left-heart decompression during venoarterial extracorporeal membrane oxygenation: an alternative to a percutaneous approach. Interact CardioVasc Thorac Surg 2010 05/01/;10(5):672–674.Google Scholar
  16. 16.
    Barbone A, Malvindi PG, Ferrara P, et al. Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation. 2011;13(3):293–295.Google Scholar
  17. 17.
    Hong TH, Byun JH, Lee HM, Kim YH, Kang G, Oh JH, et al. Initial Experience of Transaortic Catheter Venting in Patients with Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. ASAIO Journal 2016;62(2). Author, F.: Article title. Journal 2(5), 99–110 (2016).Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Faculty of Biomedical EngineeringCzech Technical University in PragueKladnoCzech Republic
  2. 2.Cardiovascular Center, Na Homolce HospitalPragueCzech Republic

Personalised recommendations