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Pressure and flow properties of cannulae for extracorporeal membrane oxygenation I: return (arterial) cannulae
LM. Broman, L. Prahl Wittberg, CJ. Westlund, M. Gilbers, L. Perry da Câmara, J. Swol, FS. Taccone, MV. Malfertheiner, M. Di Nardo, L. Vercaemst, NA. Barrett, F. Pappalardo, J. Belohlavek, T. Müller, M. Belliato, R. Lorusso,
Language English Country Great Britain
Document type Journal Article
- MeSH
- Equipment Design instrumentation MeSH
- Hemodynamics physiology MeSH
- Cannula * MeSH
- Catheterization methods MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation instrumentation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Adequate extracorporeal membrane oxygenation support in the adult requires cannulae permitting blood flows up to 6-8 L/minute. In accordance with Poiseuille's law, flow is proportional to the fourth power of cannula inner diameter and inversely proportional to its length. Poiseuille's law can be applied to obtain the pressure drop of an incompressible, Newtonian fluid (such as water) flowing in a cylindrical tube. However, as blood is a pseudoplastic non-Newtonian fluid, the validity of Poiseuille's law is questionable for prediction of cannula properties in clinical practice. Pressure-flow charts with non-Newtonian fluids, such as blood, are typically not provided by the manufacturers. A standardized laboratory test of return (arterial) cannulae for extracorporeal membrane oxygenation was performed. The aim was to determine pressure-flow data with human whole blood in addition to manufacturers' water tests to facilitate an appropriate choice of cannula for the desired flow range. In total, 14 cannulae from three manufacturers were tested. Data concerning design, characteristics, and performance were graphically presented for each tested cannula. Measured blood flows were in most cases 3-21% lower than those provided by manufacturers. This was most pronounced in the narrow cannulae (15-17 Fr) where the reduction ranged from 27% to 40% at low flows and 5-15% in the upper flow range. These differences were less apparent with increasing cannula diameter. There was a marked disparity between manufacturers. Based on the measured results, testing of cannulae including whole blood flows in a standardized bench test would be recommended.
References provided by Crossref.org
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- $a Broman, Lars Mikael $u 1 ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. 2 Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK.
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- $a Pressure and flow properties of cannulae for extracorporeal membrane oxygenation I: return (arterial) cannulae / $c LM. Broman, L. Prahl Wittberg, CJ. Westlund, M. Gilbers, L. Perry da Câmara, J. Swol, FS. Taccone, MV. Malfertheiner, M. Di Nardo, L. Vercaemst, NA. Barrett, F. Pappalardo, J. Belohlavek, T. Müller, M. Belliato, R. Lorusso,
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- $a Adequate extracorporeal membrane oxygenation support in the adult requires cannulae permitting blood flows up to 6-8 L/minute. In accordance with Poiseuille's law, flow is proportional to the fourth power of cannula inner diameter and inversely proportional to its length. Poiseuille's law can be applied to obtain the pressure drop of an incompressible, Newtonian fluid (such as water) flowing in a cylindrical tube. However, as blood is a pseudoplastic non-Newtonian fluid, the validity of Poiseuille's law is questionable for prediction of cannula properties in clinical practice. Pressure-flow charts with non-Newtonian fluids, such as blood, are typically not provided by the manufacturers. A standardized laboratory test of return (arterial) cannulae for extracorporeal membrane oxygenation was performed. The aim was to determine pressure-flow data with human whole blood in addition to manufacturers' water tests to facilitate an appropriate choice of cannula for the desired flow range. In total, 14 cannulae from three manufacturers were tested. Data concerning design, characteristics, and performance were graphically presented for each tested cannula. Measured blood flows were in most cases 3-21% lower than those provided by manufacturers. This was most pronounced in the narrow cannulae (15-17 Fr) where the reduction ranged from 27% to 40% at low flows and 5-15% in the upper flow range. These differences were less apparent with increasing cannula diameter. There was a marked disparity between manufacturers. Based on the measured results, testing of cannulae including whole blood flows in a standardized bench test would be recommended.
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- $a Prahl Wittberg, Lisa $u 4 The Linné Flow Centre and BioMEx Centre, Department of Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden.
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- $a Westlund, C Jerker $u 1 ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
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- $a Gilbers, Martijn $u 5 Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Hospital, Maastricht, The Netherlands. 6 Department of Physiology, Maastricht University, Maastricht, The Netherlands.
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- $a Perry da Câmara, Luisa $u 7 Centro Hospitalar de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal.
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- $a Swol, Justyna $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 8 Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany.
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- $a Taccone, Fabio S $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 9 Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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- $a Malfertheiner, Maximilian V $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 10 Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany.
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- $a Di Nardo, Matteo $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 11 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
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- $a Vercaemst, Leen $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 12 Department of Perfusion, University Hospital Gasthuisberg, Leuven, Belgium.
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- $a Barrett, Nicholas A $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 13 Department of Critical Care and Severe Respiratory Failure Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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- $a Pappalardo, Federico $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 14 Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
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- $a Belohlavek, Jan $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 15 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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- $a Belliato, Mirko $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 16 U.O.C. Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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- $a Lorusso, Roberto $u 3 Working Group on Innovation and Technology, EuroElso, Newcastle upon Tyne, UK. 5 Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Hospital, Maastricht, The Netherlands.
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