The Effect of Arterial Cannula Tip Position on Differential Hypoxia During Venoarterial Extracorporeal Membrane Oxygenation
Abstract Background: The interaction between native left ventricular output and venoarterial extracorporeal membrane oxygenation (VA ECMO) flow may hinder perfusion of oxygenated blood to the aortic arch branches, resulting in differential hypoxia. Typically, the arterial cannula tip is placed in the iliac artery or abdominal aorta. However, the hemodynamics of an advanced arterial cannula tip have not been studied before. This simulation study aimed to investigate the effect of altering arterial cannula tip position on VA ECMO perfusion to the upper extremities.Methods: Computational fluid dynamics simulations were performed using a patient-specific geometry of the aorta and physiologically representative boundary conditions. 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% VA ECMO support).Results: P4 was able to supply oxygenated blood to the arch vessels at all support levels, while P1 to P3 only perfused the arch vessels with 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.Conclusions: Advancing the arterial cannula tip into aortic arch increased the perfusion of blood from VA ECMO to the aortic arch vessels at all simulated support levels. In contrast, the tip position used in standard clinical practice was predicted to result in differential hypoxia during 50% and 80% support with only a slight improvement at 90% support. Therefore, during VA ECMO, advancing the arterial cannula tip has the potential to improve upper body perfusion and reduce the risk of differential hypoxia..
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Preprint| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 17. Juni Zur Gesamtaufnahme - year:2022 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wickramarachchi, Avishka [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-1535294/v1 |
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XRA03573342X |
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| 520 | |a Abstract Background: The interaction between native left ventricular output and venoarterial extracorporeal membrane oxygenation (VA ECMO) flow may hinder perfusion of oxygenated blood to the aortic arch branches, resulting in differential hypoxia. Typically, the arterial cannula tip is placed in the iliac artery or abdominal aorta. However, the hemodynamics of an advanced arterial cannula tip have not been studied before. This simulation study aimed to investigate the effect of altering arterial cannula tip position on VA ECMO perfusion to the upper extremities.Methods: Computational fluid dynamics simulations were performed using a patient-specific geometry of the aorta and physiologically representative boundary conditions. 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% VA ECMO support).Results: P4 was able to supply oxygenated blood to the arch vessels at all support levels, while P1 to P3 only perfused the arch vessels with 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.Conclusions: Advancing the arterial cannula tip into aortic arch increased the perfusion of blood from VA ECMO to the aortic arch vessels at all simulated support levels. In contrast, the tip position used in standard clinical practice was predicted to result in differential hypoxia during 50% and 80% support with only a slight improvement at 90% support. Therefore, during VA ECMO, advancing the arterial cannula tip has the potential to improve upper body perfusion and reduce the risk of differential hypoxia. | ||
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