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    Hemodynamic performance limits of the neonatal Double-Lumen cannula
    (Elsevier Ltd, 2021) Rasooli, Reza; Jamil, Muhammad; Rezaeimoghaddam, Mohammad; Yıldız, Yahya; Salihoğlu, Ece; Pekkan, Kerem
    Venovenous extracorporeal membrane oxygenation (VV-ECMO) is the preferred surgical intervention for patients suffering from severe cardiorespiratory failure, also encountered in SARS-Cov-2 management. The key component of VV-ECMO is the double-lumen cannula (DLC) that enables single-site access. The biofluid dynamics of this compact device is particularly challenging for neonatal patients due to high Reynolds numbers, tricuspid valve location and right-atrium hemodynamics. In this paper we present detailed findings of our comparative analysis of the right-atrial hemodynamics and salient design features of the 13Fr Avalon Elite DLC (as the clinically preferred neonatal cannula) with the alternate Origen DLC design, using experimentally validated computational fluid dynamics. Highly accurate 3D-reconstructions of both devices were obtained through an integrated optical coherence tomography and micro-CT imaging approach. Both cannula configurations displayed complex flow structures inside the atrium, superimposed over predominant recirculation regimes. We found that the Avalon DLC performed significantly better than the Origen alternative, by capturing 80% and 94% of venous blood from the inferior and superior vena cavae, respectively and infusing the oxygenated blood with an efficiency of more than 85%. The micro-scale geometric design features of the Avalon DLC that are associated with superior hemodynamics were investigated through 14 parametric cannula configurations. These simulations showed that the strategic placement of drainage holes, the smooth infusion blood stream diverter and efficient distribution of the venous blood capturing area between the vena cavae are associated with robust blood flow performance. Nevertheless, our parametric results indicate that there is still room for further device optimization beyond the performance measurements for both Avalon and Origen DLC in this study. In particular, the performance envelope of malpositioned cannula and off-design conditions require additional blood flow simulations for analysis.
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    Hemodynamics of neonatal double lumen cannula malposition
    (SAGE Publications Ltd., 2020) Jamil, Muhammad; Rezaeimoghaddam, Mohammad; Çakmak, Bilgesu; Yıldız, Yahya; Rasooli, Reza; Pekkan, Kerem; Salihoğlu, Ece
    Objective: Malposition of dual lumen cannula is a frequent and challenging complication in neonates and plays a significant role in shaping the in vitro device hemodynamics. This study aims to analyze the effect of the dual lumen cannula malposition on right-atrial hemodynamics in neonatal patients using an experimentally validated computational fluid dynamics model. Methods: A computer model was developed for clinically approved dual lumen cannula (13Fr Origen Biomedical, Austin, Texas, USA) oriented inside the atrium of a 3-kg neonate with normal venous return. Atrial hemodynamics and dual lumen cannula malposition were systematically simulated for two rotations (antero-atrial and atrio-septal) and four translations (two intravascular movements along inferior vena cava and two dislodged configurations in the atrium). A multi-domain compartmentalized mesh was prepared to allow the site-specific evaluation of important hemodynamic parameters. Transport of each blood stream, blood damage levels, and recirculation times are quantified and compared to dual lumen cannula in proper position. Results: High recirculation levels (39 ± 4%) in malpositioned cases resulted in poor oxygen saturation where maximum recirculation of up to 42% was observed. Apparently, Origen dual lumen cannula showed poor inferior vena cava blood–capturing efficiency (48 ± 8%) but high superior vena cava blood–capturing efficiency (86 ± 10%). Dual lumen cannula malposition resulted in corresponding changes in residence time (1.7 ± 0.5 seconds through the tricuspid). No significant differences in blood damage were observed among the simulated cases compared to normal orientation. Compared to the correct dual lumen cannula position, both rotational and translational displacements of the dual lumen cannula resulted in significant hemodynamic differences. Conclusion: Rotational or translational movement of dual lumen cannula is the determining factor for atrial hemodynamics, venous capturing efficiency, blood residence time, and oxygenated blood delivery. Results obtained through computational fluid dynamics methodology can provide valuable foresight in assessing the performance of the dual lumen cannula in patient-specific configurations.
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    Infusion jet flow control in neonatal double lumen cannulae
    (American Society of Mechanical Engineers, 2020) Rasooli, Reza; Yıldız, Yahya; Jamil, Muhammad; Pekkan, Kerem
    Clinical success of extracorporeal membrane oxygenation (ECMO) depends on the proper venous cannulation. Venovenous (VV) ECMO is the preferred clinical intervention as it provides a single-site access by utilizing a VV double lumen cannula (VVDLC) with a higher level of mobilization and physical rehabilitation. Concurrent venous blood drainage and oxygenated blood infusion in the right atrium at the presence of the cannula makes the flow dynamics complex where potential mixing of venous and oxygenated blood can drastically decreases the overall performance of ECMO. There are no studies focusing the neonatal and pediatric populations, in which the flow related effects are of paramount importance due to the small atrium size. In this study, fluid dynamics of infusion outflow jet for two commercially available neonatal VVDLC is analyzed using particle image velocimetry. Moreover, six new designs are proposed for the infusion channel geometry and compared. Important flow parameters such as flow turning angle (FTA), velocity decay, potential core and turbulent intensity are investigated for the proposed models. The experiments showed that the outflow parameters of commercial cannulae such as FTA are strongly dependent on the operating Re number. This may result in a drastic efficiency reduction for cannula operating at off-design flow conditions. Moreover, the infusion outlet tip structure and jet internal guiding pathway (JIGP) was observed to greatly affect the outflow flow features. This is of paramount importance since the anatomical positioning of the cannula and the infusion outlet is strongly dependent on the outflow properties such as FTA.