Improved Flow Dynamics of Extracorporeal Membrane Oxygenation via Design Modification of Dual-Lumen Cannulas

下腔静脉 体外膜肺氧合 生物医学工程 血栓 血栓形成 医学 血流 体外 剪应力 材料科学 上腔静脉 脉动流 静脉血栓形成 体外循环 限制 外科 冲刷 闭塞 体外循环 心脏病学 颈静脉 麻醉 腔静脉 静脉回流曲线 静脉 心脏周期
作者
Marjan Azimi,Sam Liao,Ashkan Vatani,Aidan Burrell,Shaun D. Gregory
出处
期刊:Asaio Journal [Lippincott Williams & Wilkins]
卷期号:68 (11): 1358-1366 被引量:8
标识
DOI:10.1097/mat.0000000000001669
摘要

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) supports patients with severe respiratory failure not responding to conventional treatments. Single-site jugular venous cannulation with dual-lumen cannulas (DLC) have several advantages over traditional single-lumen cannulas, however, bleeding and thrombosis are common, limiting their clinical utility. This study numerically investigated the effects of DLC side holes on blood flow dynamics since the maximum wall shear stress (WSS) occurs around the side holes. A DLC based on the Avalon Elite 27Fr model was implanted into an idealized 3D model of the vena cava and right atrium (RA). Eight DLCs were developed by changing the number, diameter, and spacing of side holes through an iterative design process. Physiologic flow at the inferior vena cava (IVC) and superior vena cava (SVC) were applied along with a partial ECMO support of 2 L/min. The SST k-ω turbulent model was solved for 6.4 seconds. WSS, washout, stagnation volume, and recirculation were compared. For all DLCs, no stasis region lasted more than one cardiac cycle and a complete washout was obtained in less than 4 seconds. Due to the IVC and SVC backflows, maximum WSS occurred around the DLC side holes at late systole and late diastole. A DLC with 16 and three side holes within the IVC and SVC, respectively, reduced the maximum WSS by up to 67% over the Avalon Elite 27Fr. Improved DLCs provided a more uniform WSS distribution with lower WSS around the side holes, potentially reducing the chance of thrombosis and bleeding.
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