Key result
Subclavian VA-ECMO provides ~42% greater superior trunk blood flow versus femoral cannulation.
Why the study?
The intricate interactions between VA-ECMO and the failing heart, and its impact on hemodynamics and perfusion, are not yet fully understood.
How do different ECMO cannulation sites and blood perfusion conditions affect aortic hemodynamics and organ perfusion in VA-ECMO?
How do different ECMO cannulation sites and blood perfusion conditions affect aortic hemodynamics and organ perfusion in VA-ECMO?
Computational fluid dynamics modeling provides insights into how VA-ECMO cannulation sites and perfusion levels impact aortic hemodynamics and organ perfusion.
May guide VA-ECMO cannulation choice by perfusion needs; leaves open human translation and outcome effects.
Extracorporeal Membrane Oxygenation (ECMO) is a medical device used to support patients with severe cardiac and/or respiratory failure. It is being used more frequently to offer percutaneous mechanical circulatory support, even though the intricate interactions between ECMO and the failing heart, as well as its impact on hemodynamics and perfusion, are not yet fully understood. Within the two main types of ECMO support (the veno-venous ECMO (VV-ECMO), which is used to support only the lungs) and the veno-arterial ECMO (VA-ECMO), which is used to support the lungs and heart), consideration is given solely to the second approach. Indeed, this study focuses on the impact of different ECMO cannulation site and blood perfusion conditions on the aortic hemodynamics and organ perfusion in VA-ECMO. Using computed tomography (CT) images, we reconstructed specific aortic models based on clinical cannula configurations and placements. A detailed cannula-aorta integration model was developed to simulate the VA-ECMO blood supply environment. Employing computational fluid dynamics (CFD), we analyzed how varying ECMO perfusion levels and ECMO cannulation sites affect flow characteristics. This study provides insights into optimizing ECMO therapy by understanding its effects on blood flow and potential damage to blood and organs.
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Gramigna et al. (2024) studied Healthy (anatomical model for simulation) (n=1). Subclavian vs. Femoral VA-ECMO cannulation vs. Femoral cannulation was evaluated on Mean flow rates in superior and inferior trunk. Subclavian VA-ECMO cannulation provided greater blood flow to the superior trunk (2.52 L/min) compared to femoral cannulation (1.78 L/min) at a 3.0 L/min ECMO flow rate, whereas femoral cannulation favored inferior trunk perfusion.
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