Patient-Specific Computational Modeling of Different Cannulation Strategies for Extracorporeal Membrane Oxygenation

Area of Science:

• Cardiovascular Physiology
• Biomedical Engineering
• Medical Imaging Analysis

Background:

• Extracorporeal membrane oxygenation (ECMO) alters native blood flow patterns to end-organ vascular beds.
• Understanding the interplay between cardiac and ECMO-driven flow is crucial for optimizing patient outcomes.
• Different ECMO configurations may lead to varied hemodynamic profiles.

Purpose of the Study:

• To investigate the hemodynamic differences in blood flow to vascular beds across various ECMO configurations.
• To analyze the contribution of cardiac versus ECMO-driven flow to different organ systems.
• To evaluate the utility of patient-specific computational fluid dynamics (CFD) in assessing ECMO hemodynamics.

Main Methods:

• Developed a patient-specific CFD model of ECMO with femoral artery cannulation (FAC).
• Augmented the model to simulate ascending aorta (AAC) and subclavian artery cannulation (SAC) configurations.
• Utilized virtual color-dye analysis to compare flow characteristics and contributions from cardiac and ECMO sources.

Main Results:

• Flow waveforms remained pulsatile in aortic branches despite predominant nonpulsatile ECMO flow.
• FAC model showed differential cardiac and ECMO flow contributions to vascular beds; AAC and SAC models demonstrated more even distribution.
• Distinct differences in hemodynamic indices, including wall shear stress and oscillatory shear index, were observed between configurations.

Conclusions:

• ECMO cannulation site significantly influences regional hemodynamics and organ perfusion.
• CFD modeling provides valuable insights into complex blood flow patterns during ECMO.
• Further clinical evaluation is warranted to understand the impact of these hemodynamic variations.