Objective: Venous-arterial venous extracorporeal membrane oxygenation (V-AV ECMO), as a new clinical application of ECMO, showed great clinical application potential in the treatment of patients with combined cardiopulmonary failure. Given the complicated cannulation strategy of V-AV ECMO, its influence on the hemodynamics of the human circulatory system remained unclear.
Methods: In this paper, a fluid-structure interaction was used to study the effect of V-AV ECMO oxygenated blood shunt ratio on right atrial recirculation and tricuspid valve (TV) blood oxygen saturation. In this study, the right atrium, superior vena cava supplying cannulae and inferior vena cava draining cannulae model of a specific patient was constructed. Seven cases with shunt ratio of 12.50%, 18.75%, 25.00%, 31.25%, 37.50%, 43.75% and 50.00% were designed.
Results: The streamline diagram and velocity contour of oxygenated blood, recirculation fraction (RF), correlation of three variables (shunt ratio, RF, and oxygen saturation), and the oxygen saturation of blood at the TV were extracted for the study. Study results showed that, first, as the shunt ratio increased, the RF of the seven cases was 14.64%, 29.87%, 33.85%, 40.12%, 40.40%, 40.02%, and 38.09%. Second, with the increase of the shunt ratio, oxygen saturation of blood at the TV in seven cases was 82.1%, 82.5%, 83.3%, 83.3%, 84.0%, 84.6%, and 85.3%.
Conclusions: In this study, the shunt ratio had a strong correlation with the RF and oxygen saturation of blood at the TV. As the shunt ratio increased, the RF initially increased and then stabilized. However, oxygen saturation of blood at the TV would increase with the increase of the shunt ratio, but the degree of increase was small. This research provided useful information for surgeons and operators using V-AV ECMO.
Keywords: fluid–structure interaction; hemodynamics; shunt ratio; venous-arterial-venous extracorporeal membrane oxygenation.