This paper reviews the basic fluid dynamics underlying extracorporeal membrane oxygenation (ECMO) cannula design. General cannula features and their effect on flow are discussed and the specific requirements of different ECMO circuits are explained. The current commercially available cannula options for veno-arterial and veno-venous circuits are reviewed and the main characteristics presented.
ChenIYHuangYCLinWH. Flow-rate measurements and models for colloid and crystalloid flows in central and peripheral venous line infusion systems. IEEE Trans Biomed Eng2002; 49: 1632–1638
JonesSA. A relationship between Reynolds stresses and viscous dissipation: implications to red cell damage. Ann Biomed Eng1995; 23: 21–28.
4.
AzizAWernerBCEptingKLAgostiCDCurtisWR. The cumulative and sublethal effects of turbulence on eryhrocytes in a stirred-tank model. Ann Biomed Eng2007; 35: 2108–2120.
5.
De BartoloCNigroAFragomeniG. Numerical and experimental flow analysis of the Wang-Zwische double-lumen cannula. ASAIO J2011; 57: 318–327.
6.
MontoyaJPMerzSIBartlettRH. A standardized system for describing flow/pressure relationships in vascular access devices. ASAIO Trans1991; 37: 4–8.
7.
SinardJMMerzSIHatcherMDMontoyaJPBartlettRH. Evaluation of extracorporeal perfusion catheters using a standardized measurement technique – the M-number. ASAIO Trans1991; 37: 60–64.
8.
DeliusREMontoyaJPMerzSI. New method for describing the performance of cardiac surgery cannulas. Ann Thorac Surg1992; 53: 278–281.
9.
AshSR. Fluid mechanics and clinical success of central venous catheters for dialysis - answers to simple but persisting problems. Sem Dial2007; 20: 237–256.
10.
WendelHPZiemerG. Coating-techniques to improve the hemocompatibility of artificial devices used for extracorporeal circulation. Eur J Cardiothorac Surg1999; 16: 341–250.
11.
PappalardoFMajGScandroglioASampietroFZangrilloAKosterA. Bioline heparin-coated ECMO with bivalirudin anticoagulation in a patient with acute heparin-induced thrombocytopenia: the immune reaction appeared to continue unabated. Perfusion2009; 24: 135–137.
12.
KosterAWengYBöttcherWGromannTKuppeHHetzerR. Successful use of bivalirudin as anticoagulant for ECMO in a patient with acute HIT. Ann Thorac Surg2007; 83: 1865–1867.
13.
RanucciMBallottaAKandilH. Bivalirudin-based versus conventional heparin anticoagulation for postcardiotomy extracorporeal membrane oxygenation. Crit Care2011; 15: R275. Epub 2011Nov20.
14.
SaitoNMotoyamaSSawamotoJ. Effects of new polymer-coated extracorporeal circuits on biocompatibility during cardiopulmonary bypass. Artif Organs2000; 24: 547–554.
15.
ZimmermannAKAebertHReizA. Hemocompatibility of PMEA coated oxygenators used for extracorporeal circulation procedures. ASAIO J2004; 50: 193–199.
16.
UeyamaKNishimuraKNichinaTNakamuraTIkedaTKomedaM. PMEA coating of pump circuit and oxygenator may attenuate the early systemic inflammatory response in cardiopulmonary bypass surgery. ASAIO J; 50: 369–372.
AlbertAABellerCJArnrichB. Is there any impact of the shape of aortic end-hole on stroke occurence? Clinical evaluation of straight and bent-tip aortic cannulae. Perfusion2002; 17: 451–456.
23.
WhiteJKJagannathATitusJYoneyamaRMadsenJAgnihotriAK. Funnel-tipped aortic cannula for reduction of atheroemboli. Ann Thorac Surg2009; 88: 551–557.
24.
CorbettSCAjdariACoskunAUNayeb-HashemiH. Effect of pulsatile flow on thrombosis potential with a step wall transition. ASAIO J2010; 56: 290–295.
25.
ParkJYParkCYMinBG. A numerical study on the effect of side holes number and arrangement in venous cannulae. J Biomech2007; 40: 1153–1157.
26.
GrigioniMDanieleCMorbiducciU. Computational model of the fluid dynamics of a cannula inserted in a vessel: incidence of the presence of side holes in blood flow. J Biomech2002; 35: 1599–1612.
27.
ParkJY. The need of slanted side holes for venous cannulae. Comput Math Methods Med2012;2012:854938. doi: 10.1155/2012/854938. Epub 2012Jan12.
28.
PranikoffTHirschlRBRemenappRSwanikerFBartlettRH. Venovenous extracorporeal life support via percutaneous cannulation in 94 patients. Chest1999; 115: 818–822.
29.
TissotCBuckvoldSPhelpsCM. Outcome of extracorporeal membrane oxygenation for early primary graft failure after pediatric heart transplantation. J Am Coll Cardiol; 54: 730–737.
30.
SoleimaniBPaeWE. Management for left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock. Perfusion2012; 27: 326–331.
31.
NaviaJLAtikFABeyerEARuda VegaP. Extracorporeal membrane oxygenation with right axillary artery perfusion. Ann Thorac Surg2005; 79: 2163–2165.
32.
ChamogeorgakisTLimaBShafiiAE. Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg2012Sep20. pii: S0022-5223(12)01087-2. doi: 10.1016/j.jtcvs.2012.08.070. Epub ahead of print.
33.
SabikJFNemehHLytleBW. Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg2004; 77: 1315–1320.
34.
MadershahianNWippermannJLiakopoulos. The acute effect of IABP-induced pulsatility on coronary vascular resistance and graft flow in critically ill patients during ECMO. J Cardiovasc Surg2011; 52: 411–418.
35.
BělohlávekJMlčekMHuptychM. Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation. Crit Care2012; 16: R50.
36.
AnastasiadisKChalvatzoulisOAntonitsisPTossiosPPapakobstantinouC. Left ventricular decompression during peripheral extracorporeal membrane oxygenation support with the use of the novel iVAC pulsatile paracorporeal assist device. Ann Thorac Surg2011; 92: 2257–2259.
37.
BeurtheretSMordantPPavieALeprinceP. Impella and extracorporeal membrane oxygenation: a demanding combination. ASAIO J2012; 58: 291–293.
38.
BrodieDBacchettaM. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med2011, 365: 1905–1924.
39.
HemmilaMRRoweSABoulesTN. Extracororeal life support for severe acute respiratory distress syndrome in adults. Ann Surg2004; 240: 595–605.
40.
MüllerTPhilippALuchnerA. A new miniaturised system for extracorporeal membrane oxygenation in adult respiratory failure. Crit Care2009; 13: R205.
41.
RichPBAwadSSCrottiSHirschlRBBartlettRHSchreinerRJ. A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenous extracorporeal life support. J Thorac Cardiovasc Surg1998; 116: 628–632.
42.
MolsGLoopTGeigerKFarthmannEBenzingA. ECMO - a ten-year experience. Am J Surg2000; 180: 144–154.
43.
KeszlerMMorontMGCoxCMiewskiMVisnerMS. Oxygen delivery with a single cannula tidal flow venovenous system for extracorporeal membrane oxygenation. ASAIO J1995; 41: 850–854.
44.
ZwischenbergerJBToomasianJMDrakeKAndrewsAFKolobowTBartlettRH. Total respiratory support with single cannula venovenous ECMO: double lumen continuous flow vs. single lumen tidal flow. Trans Am Soc Artif Intern Organs1985; 31: 610–615.