Numerical and experimental investigation of a lighthouse tip drainage cannula used in extracorporeal membrane oxygenation

Fiusco, Francesco; Rorro, Federico; Broman, Lars Mikael; Wittberg, Lisa Prahl

doi:10.1111/aor.14421

Cited by 9 publications

(3 citation statements)

References 27 publications

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“…2 B). At low ECMO flow rates the DLCs favor draining SVC blood which is expected as the holes are closer to the suction source, reflecting results reported for a pediatric DLC 18 and in adult ECMO SLCs 19 , 20 . As ECMO flow rate is increased, SVC blood supply (35% of total, 2.1 L/min) is low compared to the increased total drainage flow rate creating a negative pressure (Fig.…”

Section: Discussionsupporting

confidence: 73%

Hemodynamic and recirculation performance of dual lumen cannulas for venovenous extracorporeal membrane oxygenation

Parker

Marcial

Brismar

et al. 2023

Sci Rep

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Venovenous extracorporeal membrane oxygenation (ECMO) can be performed with two single lumen cannulas (SLCs) or one dual-lumen cannula (DLC) where low recirculation fraction ($${R}_{f}$$ R f ) is a key performance criterion. DLCs are widely believed to have lower $${R}_{f}$$ R f , though these have not been directly compared. Similarly, correct positioning is considered critical although its impact is unclear. We aimed to compare two common bi-caval DLC designs and quantify $${\mathrm{R}}_{\mathrm{f}}$$ R f in several positions. Two different commercially available DLCs were sectioned, measured, reconstructed, scaled to 27Fr and simulated in our previously published patient-averaged computational model of the right atrium (RA) and venae cavae at 2–6 L/min. One DLC was then used to simulate ± 30° and ± 60° rotation and ± 4 cm insertion depth. Both designs had low $${R}_{f}$$ R f (< 7%) and similar SVC/IVC drainage fractions and pressure drops. Both cannula reinfusion ports created a high-velocity jet and high shear stresses in the cannula (> 413 Pa) and RA (> 52 Pa) even at low flow rates. Caval pressures were abnormally high (16.2–23.9 mmHg) at low flow rates. Rotation did not significantly impact $${R}_{f}$$ R f . Short insertion depth increased $${R}_{f}$$ R f (> 31%) for all flow rates whilst long insertion only increased $${R}_{f}$$ R f at 6 L/min (24%). Our results show that DLCs have lower $${R}_{f}$$ R f compared to SLCs at moderate-high flow rates (> 4 L/min), but high shear stresses. Obstruction from DLCs increases caval pressures at low flow rates, a potential reason for increased intracranial hemorrhages. Cannula rotation does not impact $${R}_{f}$$ R f though correct insertion depth is critical.

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Section: Discussionsupporting

confidence: 73%

Hemodynamic and recirculation performance of dual lumen cannulas for venovenous extracorporeal membrane oxygenation

Parker

Marcial

Brismar

et al. 2023

Sci Rep

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“…A rich literature exists for applications of cardiovascular models, including studies on the (patho-)physiology of the human body, [4][5][6] non-invasive diagnosis of coronary artery disease, 7,8 vascular access in hemodialysis patients, 9 analysis of alternative configurations for arteriovenous fistula, 10 and cardiovascular bypass surgery. 11 Numerical models were also used to investigate and optimize the performance of medical devices, such as blood pumps, 12 drainage cannulae, 13 and coronary stents. 14 Others include clinical training 15 or inference of clinically relevant parameters such as arterial compliance and total arterial resistance, 16,17 that are not directly measurable.…”

Section: Introductionmentioning

confidence: 99%

Global sensitivity analysis with multifidelity Monte Carlo and polynomial chaos expansion for vascular haemodynamics

Schäfer,

Schiavazzi,

Hellevik

et al. 2024

Numer Methods Biomed Eng

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Computational models of the cardiovascular system are increasingly used for the diagnosis, treatment, and prevention of cardiovascular disease. Before being used for translational applications, the predictive abilities of these models need to be thoroughly demonstrated through verification, validation, and uncertainty quantification. When results depend on multiple uncertain inputs, sensitivity analysis is typically the first step required to separate relevant from unimportant inputs, and is key to determine an initial reduction on the problem dimensionality that will significantly affect the cost of all downstream analysis tasks. For computationally expensive models with numerous uncertain inputs, sample‐based sensitivity analysis may become impractical due to the substantial number of model evaluations it typically necessitates. To overcome this limitation, we consider recently proposed Multifidelity Monte Carlo estimators for Sobol’ sensitivity indices, and demonstrate their applicability to an idealized model of the common carotid artery. Variance reduction is achieved combining a small number of three‐dimensional fluid–structure interaction simulations with affordable one‐ and zero‐dimensional reduced‐order models. These multifidelity Monte Carlo estimators are compared with traditional Monte Carlo and polynomial chaos expansion estimates. Specifically, we show consistent sensitivity ranks for both bi‐ (1D/0D) and tri‐fidelity (3D/1D/0D) estimators, and superior variance reduction compared to traditional single‐fidelity Monte Carlo estimators for the same computational budget. As the computational burden of Monte Carlo estimators for Sobol’ indices is significantly affected by the problem dimensionality, polynomial chaos expansion is found to have lower computational cost for idealized models with smooth stochastic response.

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“…In the case of drainage configuration, cannulae with side holes (e.g., with a lighthouse tip (single stage)) exhibit a jet in crossflow type of behavior, characterized by strong shear layers in the drainage area (Fiusco et al. 2022 ). In the return cannula flow, using a blunt cannula, a confined jet surrounded by a co-flow develops, as shown by Lemétayer et al.…”

Section: Introductionmentioning

confidence: 99%

Effect of flow rate ratio and positioning on a lighthouse tip ECMO return cannula

Fiusco

Lemétayer

Broman

et al. 2023

Biomech Model Mechanobiol

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Extracorporeal membrane oxygenation is a life-saving support therapy in the case of cardiopulmonary refractory failure. Its use is associated to complications due to the presence of artificial surfaces and supraphysiological stress conditions. Thus, knowledge of the fluid structures associated to each component can give insight into sources of blood damage. In this study, an experimentally validated numerical study of a conventional lighthouse tip cannula in return configuration was carried out to characterize the flow structures using water or a Newtonian blood analog with different flow rate ratios and cannula positioning and their influence on hemolysis. The results showed that strong shear layers developed where the jets from the side holes met the co-flow. Stationary backflow regions at the vessel wall were also present downstream of the cannula. In the tilted case, the recirculation was much more pronounced on the wide side and almost absent on the narrow side. Small vortical backflow structures developed at the side holes which behaved like obstacles to the co-flow, creating pairs of counter-rotating vortices, which induced locally higher risk of hemolysis. However, global hemolysis index did not show significant deviations. Across the examined flow rate ratios, the holes on the narrow side consistently reinfused a larger fraction of fluid. A radial force developed in the tilted case in a direction so as to recenter the cannula in the vessel.

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Numerical and experimental investigation of a lighthouse tip drainage cannula used in extracorporeal membrane oxygenation

Cited by 9 publications

References 27 publications

Hemodynamic and recirculation performance of dual lumen cannulas for venovenous extracorporeal membrane oxygenation

Hemodynamic and recirculation performance of dual lumen cannulas for venovenous extracorporeal membrane oxygenation

Global sensitivity analysis with multifidelity Monte Carlo and polynomial chaos expansion for vascular haemodynamics

Effect of flow rate ratio and positioning on a lighthouse tip ECMO return cannula

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