Recirculation in venovenous extracorporeal membrane oxygenation (VV ECMO) leads to reduction in gas transfer efficiency. Studies of the factors contributing have been performed using in vivo studies and computational models. The fixed geometry of previous computational models limits the accuracy of results. We have developed a finite element computational fluid dynamics model incorporating fluid-structure interaction (FSI) that incorporates atrial deformation during atrial filling and emptying, with fluid flow solved using large eddy simulation. With this model, we have evaluated an extensive number of factors that could influence recirculation during two-site VV ECMO, and characterized their impact on recirculation, including cannula construction, insertion depth and orientation, VV ECMO configuration, circuit blood flow, and changes in volume, venous return, heart rate, and blood viscosity. Simulations revealed that extracorporeal blood flow relative to cardiac output, ratio of superior vena caval (SVC) to inferior vena caval (IVC) blood flow, position of the SVC cannula relative to the cavo-atrial junction, and orientation of the return cannula relative to the tricuspid valve had major influences (>20%) on recirculation fraction. Factors with a moderate influence on recirculation fraction (5%-20%) include heart rate, return cannula diameter, and direction of extracorporeal flow. Minimal influence on recirculation (<5%) was associated with atrial volume, position of the IVC cannula relative to the cavo-atrial junction, the number of side holes in the return cannula, and blood viscosity.
|Number of pages
|Published - Aug 1 2021
Bibliographical noteFunding Information:
This study was supported in part by funds from the Eminent Scholars Endowed Chair program of the Louisiana Board of Regents and from the Department of Emergency Medicine, LSU Health Sciences Center Shreveport.
© 2021 Lippincott Williams and Wilkins. All rights reserved.
- computational fluid dynamics
- finite element method
- fluid-structure interaction
- venovenous extracorporeal membrane oxygenation
ASJC Scopus subject areas
- Biomedical Engineering