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

Geier, Andreas; Kunert, Andreas; Albrecht, Günter; Liebold, Andreas; Hoenicka, Markus

doi:10.1007/s10439-017-1875-8

Cited by 20 publications

(36 citation statements)

References 30 publications

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“…Previously, our lab has investigated extracorporeal membrane oxygenation cannulation sites using an elaborate mock circulation including the DP3 diagonal pump. 5 The goal of the present study was to reassess the impact of tubing compliance on energy transfer to the patient during pulsatile operation of a MiECC in this model of adult ECC.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic energy during pulsatile extracorporeal circulation using flexible and rigid arterial tubing: a reassessment

et al. 2018

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Introduction: Pulsatile extracorporeal circulation may improve organ perfusion during cardiac surgery. Some minimally invasive extracorporeal circulation (MiECC) systems allow pulsatile perfusion. The present study investigated the influence of arterial tubing compliance on hemodynamic energy transfer into the patient. Methods: Aortic models with adult human geometry were perfused in a mock circulation. A MiECC system was connected using either high-compliance silicone tubing or standard kit tubing. Energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) were computed from flow and pressure data. Aortic models with physiological and sub-physiological compliance were tested to assess the influence of the pseudo-patient. Results: Non-pulsatile flow did not generate SHE. SHE during pulsatile flow in the compliant aortic model was significantly higher with kit tubing compared to silicone tubing. Maximum SHE was achieved at 1.6 L/min with kit tubing (7.7% of mean arterial pressure) and with silicone tubing (4.9%). Using the low-compliance aortic model, SHE with kit tubing reached a higher maximum of 14.2% at 1.8 L/min compared to silicone tubing (11.8% at 1.5 L/min). Conclusions: Flexible arterial tubing did not preserve more hemodynamic energy from a pulsatile pump compared to standard kit tubing in a model of adult extracorporeal circulation. The pseudo-patient’s compliance significantly affected the properties of the mock circulation.

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Section: Introductionmentioning

confidence: 99%

Hemodynamic energy during pulsatile extracorporeal circulation using flexible and rigid arterial tubing: a reassessment

et al. 2018

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“…We also found that central cannulation and axillary cannulation had positive effects on intraabdominal organ perfusion and femoral cannulation was inadequate for intraabdominal circulation [17]. Gaier, et al [18] found cerebral perfusion pressure to be at least as effective as the flow rate for cerebral circulation and indicated that the cerebral perfusion pressure was highest with ascending aorta and axillary artery cannulation. In another study, unilateral and bilateral cerebral perfusion were found to have no effect on mortality, but unilateral perfusion was reported to have high risk for neurological dysfunction due to variations of the circle of Willis, thus the bilateral perfusion may be more effective than study conducted by Dhuranlar, et al [10] involving 837 patients with elective, urgent and emergent ascending and aortic arch aneurysm, the PND was 2.3%.…”

Section: Discussionmentioning

confidence: 61%

“…We think that the surgical transfusion volume is influenced by the surgical variables such as the patient's preoperative condition, cardiopulmonary bypass time and postoperative revision need, but we do not think that the only risk factor is perfusion time related to cardiopulmonary bypass [17,18]. We evaluated the effects of axillary artery, ascending aorta, and femoral artery cannulations on the renal and carotid artery flows in a study that we had previously performed to investigate the relationship between organ perfusions and the cannulation sites.…”

Section: Discussionmentioning

confidence: 99%

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Neurologic and Renal Outcomes of Elective Proximal Aortic Repair and Current Cannulation Trends

İşcan¹,

Eygi²

2018

Int J Clin Cardiol

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Background: We aimed to determine factors influencing neurologic dysfunction and acute kidney injury (AKI) in patients undergoing elective aortic aneurysm repair and we also investigated them according to cannulation sites. Methods: From January 2012 to April 2018, 112 patients received proximal aortic repair. We used aortic arch, axillary and femoral artery cannulation. Antegrade cerebral protection and total circulatory arrest were used. Results: We detected 6 (5.4%) transient and 6 (5.4%) permanent neurologic dysfunction. Peripheral arterial diseases, total bypass time, transfusion and AKI showed correlation with neurologic dysfunction. Peripheral arterial diseases and AKI were independent risk factors (p < 0.05). AKI was reported in 38 patients. Postoperative revision, cross-clamp time, total bypass time and total circulatory arrest showed correlation with AKI (p < 0.05). Patients with neurologic dysfunction (66%) and patients with AKI (63%) had more femoral cannulation. Conclusion: Proximal aortic repair can be achieved with low morbidity and mortality using appropriate cerebral protection and cannulation technique. Neurologic dysfunction and AKI are important factors for aortic surgery and femoral cannulation has the highest risk for neurologic dysfunction and AKI.

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“…25 Our comprehensive MCL approach adds to the current knowledge through a systematic investigation with a high and continuous variability of all haemodynamic boundary conditions. Adding to the work of Geier et al 25 which focussed on an isolated aortic model, we assembled the complete venous and arterial vascular tree with preserved morphological structures, such as ventricles. The pneumatic-driven paracorporeal VADs allowed for the adjustment of all stages of cardiac failure with near-physiological waveforms.…”

Section: Discussionmentioning

confidence: 99%

Watershed phenomena during extracorporeal life support and their clinical impact: a systematic in vitro investigation

et al. 2020

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Aims Extracorporeal life support (ECLS) during acute cardiac failure restores haemodynamic stability and provides life-saving cardiopulmonary support. Unfortunately, all common cannulation strategies and remaining pulmonary blood flow increase left-ventricular afterload and may favour pulmonary congestion. The resulting disturbed pulmonary gas exchange and a residual left-ventricular action can contribute to an inhomogeneous distribution of oxygenated blood into end organs. These complex flow interactions between native and artificial circulation cannot be investigated at the bedside: only an in vitro simulation can reveal the underlying activities. Using an in vitro mock circulation loop, we systematically investigated the impact of heart failure, extracorporeal support, and cannulation routes on the formation of flow phenomena and flow distribution in the arterial tree. Methods and results The mock circulation loop consisted of two flexible life-sized vascular models (aorta and vena cava) driven by two paracorporeal assist devices, resistance elements, and compliance reservoirs to mimic the circulatory system. Several large-bore antegrade and retrograde access ports allowed connection to an ECLS system for extracorporeal support. With four degrees of extracorporeal support-that for cardiac failure, early recovery, late recovery, and weaning-we investigated aortic blood flow velocity, blood flow, and mixing zones using colour-coded Doppler ultrasound in the aorta and its corresponding branches. Full retrograde extracorporeal support (3-4 L/min) perfused major portions of the aorta but did not reach the supra-aortic branches and ascending aorta, resulting in an area in the thoracic aorta demonstrating nearly stagnant blood flow velocities during cardiogenic shock and early recovery (0 ± 4 cm/s; À10 ± 15 cm/s, respectively) confined by two watersheds at the aortic isthmus and renal artery origin. Even increased ECLS flow was unable to shift the watershed towards the aortic arch. Antegrade support resulted in homogeneous flow distribution during all stages of cardiac failure but created a markedly negative flow vector in the ascending aorta during cardiogenic shock and early recovery with increased afterload. Conclusions Our systematic fluid-mechanical analysis confirms the clinical assumption that despite restoring haemodynamic stability, extracorporeal support generates an inhomogeneous distribution of oxygenated blood with an inadequate supply to end organs and increased left-ventricular afterload with absent ventricular unloading. End-organ supply may be monitored by near-infrared spectroscopy, but an obviously non-controllable watershed emphasizes the need for additional measures: pre-pulmonary oxygenation with a veno-arterial-venous ECLS configuration can allow a transpulmonary passage of oxygenated blood, providing improved end-organ supply.

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

Cited by 20 publications

References 30 publications

Hemodynamic energy during pulsatile extracorporeal circulation using flexible and rigid arterial tubing: a reassessment

Hemodynamic energy during pulsatile extracorporeal circulation using flexible and rigid arterial tubing: a reassessment

Neurologic and Renal Outcomes of Elective Proximal Aortic Repair and Current Cannulation Trends

Watershed phenomena during extracorporeal life support and their clinical impact: a systematic in vitro investigation

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