Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation-an in silico simulation study - Research portal of Justus Liebig University Giessen:

Conference paper

Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation-an in silico simulation study

Authors list: Bongert, Markus; Gehron, Johannes; Geller, Marius; Böning, Andreas; Grieshaber, Philippe

Publication year: 2019

Pages: 312-319

Journal: Interdisciplinary Cardiovascular and Thoracic Surgery

Volume number: 29

Issue number: 2

ISSN: 1569-9293

eISSN: 1569-9285

DOI Link: https://doi.org/10.1093/icvts/ivz048

Conference: 32nd Annual Meeting of the European Association for Cardio-Thoracic Surgery

Publisher: Oxford University Press

Abstract:
OBJECTIVES: Limb ischaemia during extracorporeal life support (ECLS) using femoral artery cannulation is frequently observed even in patients with regular vessel diameters and without peripheral arterial occlusive disease. We investigated underlying pathomechanisms using a virtual fluid-mechanical simulation of the human circulation.METHODS: A life-sized model of the human aorta and major vascular branches was virtualized using 3-dimensional segmentation software (Mimics, Materialise). Steady-state simulation of different grades of cardiac output (0-100%) was performed using Computational Fluid Dynamics (CFX, ANSYS). A straight cannula [virtualized 16 Fr (5.3 mm)] was inserted into the model via the left common femoral artery. The ECLS flow was varied between 1 and 51/min. The pressure boundary conditions at the arterial outlets were selected to demonstrate the downstream vascular system. Qualitative and quantitative analyses concerning flow velocity and direction were carried out in various regions of the model.RESULTS: During all simulated stages of reduced cardiac output and subsequently adapted ECLS support, retrograde blood flow originating from the ECLS cannula was observed from the cannulation site up to the aortic bifurcation. Analysis of pressure showed induction of zones of negative pressure close to the cannula tip, consistent with the Bernoulli principle. Depending on cannula position and ECLS flow rate, this resulted in negative flow from the ipsilateral superficial femoral artery or the contralateral internal iliac artery. The antegrade flow to the non-cannulated side was generally greater than that to the cannulated side.CONCLUSIONS: The cannula position and ECLS flow rate both influence lower limb perfusion during femoral ECLS. Therefore, efforts to optimize the cannula position and to avoid limb malperfusion, including placement of a distal perfusion cannula, should be undertaken in patients treated with ECLS.

Authors/Editors

- Dr. biol. hom. Johannes Gehron, M.Sc.

Citation Styles

Harvard Citation style: Bongert, M., Gehron, J., Geller, M., Böning, A. and Grieshaber, P. (2019) Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation-an in silico simulation study, Interactive Cardiovascular and Thoracic Surgery, 29(2), pp. 312-319. https://doi.org/10.1093/icvts/ivz048

APA Citation style: Bongert, M., Gehron, J., Geller, M., Böning, A., & Grieshaber, P. (2019). Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation-an in silico simulation study. Interactive Cardiovascular and Thoracic Surgery. 29(2), 312-319. https://doi.org/10.1093/icvts/ivz048