PMID- 33895658
OWN - NLM
STAT- MEDLINE
DCOM- 20210519
LR  - 20221217
IS  - 1873-2380 (Electronic)
IS  - 0021-9290 (Print)
IS  - 0021-9290 (Linking)
VI  - 121
DP  - 2021 May 24
TI  - Hemodynamic performance limits of the neonatal Double-Lumen cannula.
PG  - 110382
LID - S0021-9290(21)00162-7 [pii]
LID - 10.1016/j.jbiomech.2021.110382 [doi]
AB  - Venovenous extracorporeal membrane oxygenation (VV-ECMO) is the preferred 
      surgical intervention for patients suffering from severe cardiorespiratory 
      failure, also encountered in SARS-Cov-2 management. The key component of VV-ECMO 
      is the double-lumen cannula (DLC) that enables single-site access. The biofluid 
      dynamics of this compact device is particularly challenging for neonatal patients 
      due to high Reynolds numbers, tricuspid valve location and right-atrium 
      hemodynamics. In this paper we present detailed findings of our comparative 
      analysis of the right-atrial hemodynamics and salient design features of the 13Fr 
      Avalon Elite DLC (as the clinically preferred neonatal cannula) with the 
      alternate Origen DLC design, using experimentally validated computational fluid 
      dynamics. Highly accurate 3D-reconstructions of both devices were obtained 
      through an integrated optical coherence tomography and micro-CT imaging approach. 
      Both cannula configurations displayed complex flow structures inside the atrium, 
      superimposed over predominant recirculation regimes. We found that the Avalon DLC 
      performed significantly better than the Origen alternative, by capturing 80% and 
      94% of venous blood from the inferior and superior vena cavae, respectively and 
      infusing the oxygenated blood with an efficiency of more than 85%. The 
      micro-scale geometric design features of the Avalon DLC that are associated with 
      superior hemodynamics were investigated through 14 parametric cannula 
      configurations. These simulations showed that the strategic placement of drainage 
      holes, the smooth infusion blood stream diverter and efficient distribution of 
      the venous blood capturing area between the vena cavae are associated with robust 
      blood flow performance. Nevertheless, our parametric results indicate that there 
      is still room for further device optimization beyond the performance measurements 
      for both Avalon and Origen DLC in this study. In particular, the performance 
      envelope of malpositioned cannula and off-design conditions require additional 
      blood flow simulations for analysis.
CI  - Copyright (c) 2021 Elsevier Ltd. All rights reserved.
FAU - Rasooli, Reza
AU  - Rasooli R
AD  - Mechanical Engineering, Koc University, Turkey.
FAU - Jamil, Muhammad
AU  - Jamil M
AD  - Mechanical Engineering, Koc University, Turkey.
FAU - Rezaeimoghaddam, Mohammad
AU  - Rezaeimoghaddam M
AD  - Mechanical Engineering, Koc University, Turkey.
FAU - Yildiz, Yahya
AU  - Yildiz Y
AD  - School of Medicine, Medipol University, Turkey.
FAU - Salihoglu, Ece
AU  - Salihoglu E
AD  - School of Medicine, Biruni University, Turkey.
FAU - Pekkan, Kerem
AU  - Pekkan K
AD  - Mechanical Engineering, Koc University, Turkey. Electronic address: 
      kpekkan@ku.edu.tr.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210415
PL  - United States
TA  - J Biomech
JT  - Journal of biomechanics
JID - 0157375
SB  - IM
MH  - *COVID-19
MH  - Cannula
MH  - *Extracorporeal Membrane Oxygenation
MH  - Hemodynamics
MH  - Humans
MH  - Infant, Newborn
MH  - SARS-CoV-2
PMC - PMC9750623
OTO - NOTNLM
OT  - Biofluid mechanics
OT  - Cardiovascular devices
OT  - Congenital heart defects
OT  - Hemodynamics
OT  - Hemolysis and thrombogenicity
OT  - micro-CT
EDAT- 2021/04/26 06:00
MHDA- 2021/05/20 06:00
PMCR- 2021/04/15
CRDT- 2021/04/25 20:45
PHST- 2021/03/04 00:00 [received]
PHST- 2021/03/10 00:00 [accepted]
PHST- 2021/04/26 06:00 [pubmed]
PHST- 2021/05/20 06:00 [medline]
PHST- 2021/04/25 20:45 [entrez]
PHST- 2021/04/15 00:00 [pmc-release]
AID - S0021-9290(21)00162-7 [pii]
AID - 110382 [pii]
AID - 10.1016/j.jbiomech.2021.110382 [doi]
PST - ppublish
SO  - J Biomech. 2021 May 24;121:110382. doi: 10.1016/j.jbiomech.2021.110382. Epub 2021 
      Apr 15.