Flow capabilities of arterial and drainage cannulae during venoarterial extracorporeal membrane oxygenation: A simulation model

Author:

Wickramarachchi Avishka1ORCID,Burrell Aidan J. C.23,Joyce Patrick R.2,Bellomo Rinaldo3456,Raman Jaishankar7,Gregory Shaun D.1,Stephens Andrew F.1

Affiliation:

1. Cardio-Respiratory Engineering and Technology Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia

2. Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia

3. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia

4. Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia

5. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia

6. Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia

7. Cardiothoracic Surgery, University of Melbourne, Austin & St Vincent’s Hospitals, Melbourne, VIC, Australia

Abstract

Background Large cannulae can increase cannula-related complications during venoarterial extracorporeal membrane oxygenation (VA ECMO). Conversely, the ability for small cannulae to provide adequate support is poorly understood. Therefore, we aimed to evaluate a range of cannula sizes and VA ECMO flow rates in a simulated patient under various disease states. Methods Arterial cannulae sizes between 13 and 21 Fr and drainage cannula sizes between 21 and 25 Fr were tested in a VA ECMO circuit connected to a mock circulation loop simulating a patient with severe left ventricular failure. Systemic and pulmonary hypertension, physiologically normal, and hypotension were simulated by varying systemic and pulmonary vascular resistances (SVR and PVR, respectively). All cannula combinations were evaluated against all combinations of SVR, PVR, and VA ECMO flow rates. Results A 15 Fr arterial cannula combined with a 21 Fr drainage cannula could provide >4 L/min of total flow and a mean arterial pressure of 81.1 mmHg. Changes in SVR produced marked changes to all measured parameters, while changes to PVR had minimal effect. Larger drainage cannulae only increased maximum circuit flow rates when combined with larger arterial cannulae. Conclusion Smaller cannulae and lower flow rates could sufficiently support the simulated patient under various disease states. We found arterial cannula size and SVR to be key factors in determining the flow-delivering capabilities for any given VA ECMO circuit. Overall, our results challenge the notion that larger cannulae and high flows must be used to achieve adequate ECMO support.

Funder

National Health and Medical Research Council

National Heart Foundation of Australia

Publisher

SAGE Publications

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