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. 2016 Mar 3:22:717-26.
doi: 10.12659/msm.895831.

Hemodynamic Differences Between Central ECMO and Peripheral ECMO: A Primary CFD Study

Kaiyun Gu  1 , Ya Zhang  2 , Bin Gao  2 , Yu Chang  2 , Yi Zeng  2
Affiliations

Hemodynamic Differences Between Central ECMO and Peripheral ECMO: A Primary CFD Study

Kaiyun Gu et al. Med Sci Monit. .

Abstract

BACKGROUND Veno-arterial extracorporeal membrane oxygenation (VAECMO), including central ECMO (cECMO) and peripheral ECMO (pECMO), is widely used in cardiopulmonary surgery. The outcomes and complications of both types of ECMO are quite different from each other. The hemodynamic differences among them are hypothesized as a key factor. Hence, a numerical study was conducted to test this hypothesis. MATERIAL AND METHODS Ideal cardiovascular models with pECMO and cECMO were established. The aortic pressure and flow rate were chosen as boundary conditions. The flow pattern, blood flow distributions, flow junction, harmonic index (HI) of blood flow, wall shear stress (WSS), and the oscillatory shear index (OSI) were calculated to evaluate the hemodynamic states. RESULTS pECMO could achieve better upper limb and brain perfusion (0.05458 vs. 0.05062 kg/s), and worse lower limb perfusion (0.03067 vs. 0.03401 kg/s). There exist low WSS (<0.4 pa) regions at the inner and posterior wall of the aorta, and high WSS (>2 pa) region at the access of the femoral artery. These regions also have relatively high OSI value (reaching 0.45). In contrast, for cECMO, there exist high WSS at the posterior wall of the aortic arch. CONCLUSIONS The hemodynamic performances of various types of ECMO are different from each other, which maybe the key reasons for the differences in the outcomes and complications. Therefore, for pEMCO, the lower-extremity ischemia is a complication that must be considered. The type, support level, and duration of ECMO should also be carefully regulated according to the patients' condition, as they are the important factors related to vascular complications.

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Figures

Figure 1
Figure 1
The ideal 3-dimensional geometric model of peripheral and cECMO and related blood vessels. (A) is the model of pECMO and (B) is the model of cECMO.
Figure 2
Figure 2
The inlet flow rate waveforms of the aorta and selected time for later analysis.
Figure 3
Figure 3
Flow rate of all the outlets of the cases. (A) is the flow rate of pECMO and (B) is the flow rate of cECMO.
Figure 4
Figure 4
Flow rate ratio of the 2 modes. A is the Rup of 2 modes of ECMO and B is the Rdown of 2 modes of ECMO.
Figure 5
Figure 5
Velocity vector of aorta arch and femoral bifurcation at different times in the 2 modes of ECMO. (A, C) are the velocity vectors of pECMO, while (B, D) are the velocity vectors of cECMO.
Figure 6
Figure 6
Wall shear stress (WSS) contours at different times in the 2 modes of ECMO. (A, C) are the wall shear stress (WSS) contours of pECMO, while (B, D) are the wall shear stress (WSS) contours of cECMO.
Figure 7
Figure 7
Wall shear stress of selected regions at 1 cardiac cycle. (A) is the selected 3 region, (B) is the wall shear stress of region 1 at 1 cardiac cycle, (C) is the wall shear stress of region 2 at 1 cardiac cycle, and (C) is the wall shear stress of region 3 at 1 cardiac cycle.
Figure 8
Figure 8
OSI of the 2 modes of ECMO. (A) is the OSI of pECMO and (B) is the OSI of cECMO.
See this image and copyright information in PMC

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