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An experimental model of veno-venous arterial extracorporeal membrane oxygenation.

  • Belliato, Mirko1
  • Caneva, Luca1
  • Aina, Alessandro2
  • Degani, Antonella3
  • Mongodi, Silvia1
  • Prahl Wittberg, Lisa4
  • Pellegrini, Carlo3, 5
  • Broman, Lars M6
  • Iotti, Giorgio Antonio1, 5
  • 1 UOC Anestesia e Rianimazione, IRCCS Policlinico San Matteo, Pavia, Italy. , (Italy)
  • 2 Department of Cardiac Surgery and Cardiovascular Perfusion,Ospedale San Raffaele Milano, Italy. , (Italy)
  • 3 UOC Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. , (Italy)
  • 4 The Linné Flow Centre and BioMEx Centre, Department of Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden. , (Sweden)
  • 5 Department of Surgical, Pediatric, and Diagnostic Sciences, University of Pavia, Pavia, Italy. , (Italy)
  • 6 ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. , (Sweden)
Published Article
The International Journal of Artificial Organs
SAGE Publications
Publication Date
Nov 06, 2019
DOI: 10.1177/0391398819882024
PMID: 31692415


Veno-venous arterial extracorporeal membrane oxygenation is a hybrid-modality of extracorporeal membrane oxygenation combining veno-venous and veno-arterial extracorporeal membrane oxygenation. It may be applied to patients with both respiratory and cardio-circulatory failure. To describe a computational spreadsheet regarding an ex vivo experimental model of veno-venous arterial extracorporeal membrane oxygenation to determine the return of cannula pairs in a single pump-driven circuit. We developed an ex vivo model of veno-venous arterial extracorporeal membrane oxygenation with a single pump and two outflow cannulas, and a glucose solution was used to mimic the features of blood. We maintained a fixed aortic impedance and physiological pulmonary resistance. Both flow and pressure data were collected while testing different pairs of outflow cannulas. Six simulations of different cannula pairs were performed, and data were analysed by a custom-made spreadsheet, which was able to predict the flow partition at different flow levels. In all simulations, the flow in the arterial cannula gradually increased differently depending on the cannula pair. The best cannula pair was a 19-Fr/18-cm arterial with a 17-Fr/50-cm venous cannula, where we observed an equal flow split and acceptable flow into the arterial cannula at a lower flow rate of 4 L/min. Our computational spreadsheet identifies the suitable cannula pairing set for correctly splitting the outlet blood flow into the arterial and venous return cannulas in a veno-venous arterial extracorporeal membrane oxygenation configuration without the use of external throttles. Several limitations were reported regarding fixed aortic impedance, central venous pressure and the types of cannulas tested; therefore, further studies are mandatory to confirm our findings.

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