PMID- 32866998 OWN - NLM STAT- MEDLINE DCOM- 20210308 LR - 20210308 IS - 1525-1594 (Electronic) IS - 0160-564X (Linking) VI - 45 IP - 2 DP - 2021 Feb TI - Assessing potential for aortoiliac vascular injury from venoarterial extracorporeal membrane oxygenation cannulae: An in vitro particle image velocimetry study. PG - E14-E25 LID - 10.1111/aor.13807 [doi] AB - Limb ischemia is a major complication associated with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The high velocity jet from arterial cannulae can cause "sandblasting" injuries to the arterial endothelium, with the potential risk of distal embolization and end organ damage. The aim of this study was to identify, for a range of clinically relevant VA-ECMO cannulae and flow rates, any regions of peak flow velocity on the aortic wall which may predispose to vascular injury, and any regions of low-velocity flow which may predispose to thrombus formation. A silicone model of the aortic and iliac vessels was sourced and the right external iliac artery was cannulated. Cannulae ranged from 15 to 21 Fr in size. Simulated steady state ECMO flow rates were instituted using a magnetically levitated pump (CentriMag pump). Adaptive particle image velocimetry was performed for each cannula at 3, 3.5, 4, and 4.5 L/min. For all cannulae, in both horizontal and vertical side hole orientations, the peak velocity on the aortic wall ranged from 0.3 to 0.45 m/s, and the regions of lowest velocity flow were 0.05 m/s. The magnitude of peak velocity flow on the aortic wall was not different between a single pair versus multiple pairs of side holes. Maximum velocity flow on the aortic wall occurred earlier at a lower pump flow rate in the vertical orientation of distal side holes compared to a horizontal position. The presence of multiple paired side holes was associated with fewer low-velocity flow regions, and some retrograde flow, in the distal abdominal aorta compared to cannulae with a single pair of side holes. From this in vitro visualization study, the selection of a cannula design with multiple versus single pairs of side holes did not change the magnitude of peak velocity flow delivered to the vessel wall. Cannulae with multiple side holes were associated with fewer regions of low-velocity flow in the distal abdominal aorta. Further in vivo studies, and ideally clinical data would be required to assess any correlation of peak velocity flows with incidence of vascular injury, and any low-velocity flow regions with incidence of thrombosis. CI - (c) 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC. FAU - Haymet, Andrew B AU - Haymet AB AUID- ORCID: 0000-0001-6511-0081 AD - Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. AD - Critical Care Research Group (CCRG), The Prince Charles Hospital (TPCH), Brisbane, QLD, Australia. AD - Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), CCRG, TPCH, Brisbane, QLD, Australia. FAU - Boone, Alice AU - Boone A AUID- ORCID: 0000-0002-5428-3048 AD - Critical Care Research Group (CCRG), The Prince Charles Hospital (TPCH), Brisbane, QLD, Australia. AD - Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), CCRG, TPCH, Brisbane, QLD, Australia. AD - School of Engineering and Built Environment, Griffith University, Southport, QLD, Australia. FAU - Vallely, Michael P AU - Vallely MP AD - Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. FAU - Malfertheiner, Maximilian Valentin AU - Malfertheiner MV AD - Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. FAU - Pauls, Jo P AU - Pauls JP AD - Critical Care Research Group (CCRG), The Prince Charles Hospital (TPCH), Brisbane, QLD, Australia. AD - Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), CCRG, TPCH, Brisbane, QLD, Australia. AD - School of Engineering and Built Environment, Griffith University, Southport, QLD, Australia. FAU - Suen, Jacky Y AU - Suen JY AD - Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. AD - Critical Care Research Group (CCRG), The Prince Charles Hospital (TPCH), Brisbane, QLD, Australia. AD - Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), CCRG, TPCH, Brisbane, QLD, Australia. FAU - Fraser, John F AU - Fraser JF AD - Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. AD - Critical Care Research Group (CCRG), The Prince Charles Hospital (TPCH), Brisbane, QLD, Australia. AD - Innovative Cardiovascular Engineering and Technology Laboratory (ICETLAB), CCRG, TPCH, Brisbane, QLD, Australia. LA - eng GR - EQ2019-07/The Common Good, an initiative of The Prince Charles Hospital Foundation/ PT - Journal Article DEP - 20201015 PL - United States TA - Artif Organs JT - Artificial organs JID - 7802778 SB - IM MH - Aorta, Abdominal/injuries MH - Blood Flow Velocity MH - Cannula/adverse effects MH - Equipment Design MH - Extracorporeal Membrane Oxygenation/*adverse effects/instrumentation MH - Extremities/*blood supply MH - Humans MH - Iliac Artery/injuries MH - Ischemia/etiology/physiopathology/*prevention & control MH - *Models, Cardiovascular MH - Rheology MH - Vascular System Injuries/etiology/physiopathology/*prevention & control OTO - NOTNLM OT - cannula OT - extracorporeal membrane oxygenation OT - mechanical circulatory support OT - vascular EDAT- 2020/09/01 06:00 MHDA- 2021/03/09 06:00 CRDT- 2020/09/01 06:00 PHST- 2020/05/30 00:00 [received] PHST- 2020/07/21 00:00 [revised] PHST- 2020/08/19 00:00 [accepted] PHST- 2020/09/01 06:00 [pubmed] PHST- 2021/03/09 06:00 [medline] PHST- 2020/09/01 06:00 [entrez] AID - 10.1111/aor.13807 [doi] PST - ppublish SO - Artif Organs. 2021 Feb;45(2):E14-E25. doi: 10.1111/aor.13807. Epub 2020 Oct 15.