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The effect of arterial cannula tip position on differential hypoxemia during venoarterial extracorporeal membrane oxygenation

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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.

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Abbreviations

VA ECMO:

Venoarterial extracorporeal membrane oxygenation

CFD:

Computational fluid dynamics

P1, P2, P3 and P4:

Position 1, position 2, position 3 and position 4

CT:

Computed tomography

ECPR:

Extracorporeal cardiopulmonary resuscitation

BCA:

Brachiocephalic artery

LCCA:

Left common carotid artery

LSCA:

Left subclavian artery

SMA:

Superior mesenteric artery

IMA:

Inferior mesenteric artery

LCI:

Left common iliac

RCI:

Right common iliac

LV:

Left ventricle

MAP:

Mean aortic pressure

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Acknowledgements

The authors wish to acknowledge Dr. Tim Joseph for their efforts in acquiring the computed tomography scans which were then used to generate the 3D model of the aorta.

Funding

This work was supported by Monash University. Shaun D Gregory is the recipient of a Fellowship (102062) from the National Heart Foundation of Australia.

Author information

Authors and Affiliations

  1. Cardio-Respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia

    Avishka Wickramarachchi, Andrew F. Stephens, Michael Šeman, Ashkan Vatani, Mehrdad Khamooshi & Shaun D. Gregory

  2. Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia

    Avishka Wickramarachchi, Andrew F. Stephens, Ashkan Vatani, Mehrdad Khamooshi & Shaun D. Gregory

  3. Intensive Care Unit, Alfred Hospital, Melbourne, Australia

    Aidan J. C. Burrell

  4. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Aidan J. C. Burrell & Rinaldo Bellomo

  5. School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia

    Michael Šeman

  6. Department of Cardiology, Alfred Health, Melbourne, Australia

    Michael Šeman

  7. Cardiothoracic Surgery, Austin & St Vincent’s Hospitals, University of Melbourne, Melbourne, Australia

    Jaishankar Raman

  8. Intensive Care Unit, Austin Hospital, Melbourne, Australia

    Rinaldo Bellomo

  9. Department of Critical Care, The University of Melbourne, Melbourne, Australia

    Rinaldo Bellomo

  10. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia

    Rinaldo Bellomo

Authors
  1. Avishka Wickramarachchi
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Contributions

JR and RB proposed the idea of a long arterial cannula that could be positioned close to the arch of the aorta to maximize blood flow to the brain during ECMO; this was based on preliminary unpublished animal work. AW designed the study, developed the CFD model, conducted the CFD simulations and wrote the main draft of the manuscript. AB and MS designed the study and provided valuable clinical input towards the final draft of the manuscript. AS, MS, AV and MK aided in the interpretation of the data and provided vital contributions to the drafting of the manuscript. AV and MK also provided assistance with CFD modelling. JR and RB provided valuable clinical input and contributed towards the final draft of the manuscript contents. SG designed the study, aided in the interpretation of data and contributed towards the final draft of the manuscript.

Corresponding author

Correspondence to Avishka Wickramarachchi.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

Anonymized patient imaging and demographic data was used in this article in accordance with ethics approval from The Alfred Ethics Committee. Therefore, informed consent was not required.

Consent for publication

This manuscript has been approved for publication for this journal by all authors. Informed consent was not required from the patient as their imaging and demographic data was used in accordance with ethics approval from The Alfred Ethics Committee.

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Supplementary Information

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Additional File 1: Details of the meshing process and mesh sensitivity analysis. Supplementary file1 (DOCX 634 kb)

13246_2022_1203_MOESM2_ESM.docx

Additional File 2: Description of the Windkessel outlet boundary condition and the respective resistance and compliance parameters for each aortic branch. Supplementary file2 (DOCX 34 kb)

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Wickramarachchi, A., Burrell, A.J.C., Stephens, A.F. et al. The effect of arterial cannula tip position on differential hypoxemia during venoarterial extracorporeal membrane oxygenation. Phys Eng Sci Med 46, 119–129 (2023). https://doi.org/10.1007/s13246-022-01203-6

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  • DOI: https://doi.org/10.1007/s13246-022-01203-6

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