Hemodynamic Differences Between Central ECMO and Peripheral ECMO: A Primary CFD Study

Gu, Kai; Ya, Zhang; Gao, Bin; Chang, Yu; Zeng, Yong

doi:10.12659/msm.895831

Cited by 37 publications

(25 citation statements)

References 45 publications

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“…Based on the above similar studies, we also tried to use CFD to explain clinical problems, such as the hemodynamic difference between different arterial cannulations. In our previous study, central cannulation was found to provide the best-oxygenated flow and pressure to carotid arteries (CA), and AAC preferentially perfused the right CA at the expense of the left CA in the extracorporeal membrane oxygenation CFD model (25). In the present study, our CFD results demonstrated that both AAC and IAC significantly increased the blood flow of the axillary artery, innominate artery, and renal artery.…”

Section: Discussionsupporting

confidence: 61%

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

et al. 2021

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Background:The aim of the present study was to use a numerical simulation based on computational fluid dynamics (CFD) to analyze the difference of different cannulation methods on hemodynamics characteristic in a type A aortic dissection (TAAD) model. Methods:A finite-element analysis based on the CFD model of a TAAD patient was used, and axillary artery cannulation (AAC), innominate artery cannulation (IAC), and femoral artery cannulation (FAC) were analyzed under different situations, including a cardiac output (CO) of 2.5 L/min and cardiopulmonary bypass (CPB) of 2.5 L/min (partial CPB before cross-clamping aorta, defined as condition A), and a CO of 0 L/min and CPB of 5 L/min (aortic cross-clamping phase, defined as condition B). The insertion of an 8-mm cannula into the different models was simulated. Hemodynamic characteristics, including wall shear stress, wall stress, blood flow, and velocity were analyzed.Results: In condition A, the total flow of branches of the aortic arch was 2,009.5 mL/min (AAC), 1,855.47 mL/min (IAC), and 1,648.03 mL/min (FAC). All cannulation methods improved left renal blood perfusion. However, in relation to blood flow in the right renal artery, FAC showed the highest blood flow (105 mL/min). The results in condition B were similar to those of condition A. The velocity, shear stress, and stress of entry tear via AAC and IAC decreased in condition B compared with condition A. The velocity, shear stress, stress of tear via AAC was lower than that of IAC.Conclusions: Different cannulation modes have an effect on the hemodynamic characteristic of the tear, but this effect is related to different states of CPB. AAC was found to superior to IAC, especially in reducing velocity, stress, and shear stress of site of tear. However, IAC and AAC are more conductive to blood supply than FAC in branch vessels of the aortic arch without being affected by the CPB state.

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Section: Discussionsupporting

confidence: 61%

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

et al. 2021

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“…This phenomenon was attributed to skewing of the direction of the cannula jet toward the descending aorta (16). Gu et al used a CFD simulation and reported a higher flow rate and lower wall shear stress in the carotid artery with pECMO than with cECMO due to greater flow in the direction of the carotid artery (17). In our study, we also confirmed greater blood flow to the brain in the pECMO group compared to the cECMO group, as measured in the brachiocephalic artery.…”

Section: Discussionsupporting

confidence: 83%

Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation

et al. 2018

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Background: In veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a patient is cannulated using either an atrio-aortic technique (central type ECMO; cECMO) or a femoro-femoral technique (peripheral type ECMO; pECMO). The direction of the pump flow at the aortic arch is anterograde from the ascending aorta in cECMO and retrograde from the descending aorta in pECMO. Hemodynamic differences from the position of the cannulas may influence the brain differently. To evaluate the effect of ECMO cannula positioning on the brain, hemodynamic data and plasma biomarkers were collected. Methods: Eight pigs were randomly divided into the cECMO group (n=4) or pECMO group (n=4). ECMO was administered for 6 hours at a pump flow rate based on the mean flow of the ascending aorta. Mean arterial pressure (MAP), mean arterial flow (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured in the brachiocephalic artery every 30 minutes. During ECMO treatment, plasma was collected for analysis of interleukin-6 (IL-6), S100B, glial fibrillary acidic protein (GFAP), and neuron-specific enolase. The data were analyzed using the Mann-Whitney U tests, and repeated measures ANOVAs; significance was set at P<0.

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“…Therefore, we could suppose that platelet impairment may vary also according to different ECMO configurations (i.e. central vs. peripheral cannulation) [4,5,47].…”

Section: Discussionmentioning

confidence: 99%

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9-29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6-61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8-34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8-5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.

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Hemodynamic Differences Between Central ECMO and Peripheral ECMO: A Primary CFD Study

Cited by 37 publications

References 45 publications

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics

Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

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