Open Access

ARTICLE

Numerical Study on Hemodynamic Characteristics and Distribution of Oxygenated Flow Associated with Cannulation Strategies in Veno-Arterial Extracorporeal Membrane Oxygenation Support

Da Li¹, Yuqing Tian¹, Chengxin Weng^2,3, Fuyou Liang^1,4,5,*

1 Department of Engineering Mechanics, School of Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
2 Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
3 Department of General Surgery 1 (Hepato-Pancreato-Biliary Surgery & Vascular Surgery), West China Tianfu Hospital, Sichuan University, Chengdu, 610065, China
4 State Key Laboratory of Ocean Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
5 Institute for Computer Science and Mathematical Modeling, Sechenov First Moscow State Medical University, Moscow, 119991, Russia

* Corresponding Author: Fuyou Liang. Email:

Computer Modeling in Engineering & Sciences 2025, 143(3), 2867-2882. https://doi.org/10.32604/cmes.2025.066444

Received 08 April 2025; Accepted 11 June 2025; Issue published 30 June 2025

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure. However, the choice of cannulation strategy remains contentious, partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation. In this study, a geometrical multiscale model was built to offer a mathematical tool for addressing the issue. The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation, whereas it was inserted into the right subclavian artery (RSA) or the left iliac artery (LIA) in the case of peripheral cannulation. Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries. Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas, although the area of aortic walls exposed to abnormal wall shear stress (WSS) was considerably enlarged in comparison with the normal physiological condition. In contrast, the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body (with ECMO flow fractions < 0.5), but also induced marked flow disturbance in the aorta, causing about 40% of the abdominal aortic wall and over 65% of the resting aortic wall to suffer from high time-averaged WSS (>5 Pa) and low time-averaged WSS (<0.4 Pa), respectively. The LIA cannulation also resulted in significantly prolonged blood residence time (>40 s) in the ascending aorta, which, along with abnormal WSS, may considerably increase the risk of thrombosis. In summary, our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution. The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.

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Supplementary Material

Supplementary Material File

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