Fluid Flow Analysis of Neonatal Dual-Lumen Cannulas for Venovenous Extracorporeal Membrane Oxygenation

Hemolysis persists as a common and serious problem for neonatal patients on extracorporeal membrane oxygenation (ECMO). Since the cannula within the ECMO circuit is associated with hemolysis-inducing shear stresses, real-world internal fluid flow measurements are urgently needed to understand the mechanism and confirm computational estimates. This study appears to be the first experimental study of fluid flow inside commercial ECMO dual-lumen cannulas (DLCs) and first particle image velocimetry (PIV) visualization inside a complicated medical device. The internal geometries of four different opaque neonatal DLCs, both atrial and bicaval positioning geometries each sized 13 Fr and 16 Fr, were replicated by three-dimensional printing clear lumen scaled-up models, which were integrated in a circuit with appropriate ECMO flow parameters. PIV was then used to visualize two-dimensional fluid flow in a single cross section within the models. An empirical model accounting for shear stress and exposure time was used to compare the maximum expected level of hemolysis through each model. The maximum measured peak shear stress recorded was 16$±$2 Pa in the top arterial bicaval 13 Fr model. The atrial and 16 Fr cannula models never produced greater single-pass peak shear stress or hemolysis than the bicaval and 13 Fr models, respectively, and no difference was found in hemolysis at two different flow rates. After 5 days of flow, small DLC-induced hemolysis values for a single pass through each cannula were modeled to linearly accumulate and caused the most severe hemolysis in the bicaval 13 Fr DLC. Engineering and clinical solutions to improve cannula safety are proposed.