Expandable ECMO Extension Cannula for Selective Aortic Perfusion
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Solution Overview
Problem
Current VA-ECMO systems cause complications such as kidney injury, stroke, and vascular injury due to peripheral cannulation, and they often require additional vascular access for interventional procedures, which can be challenging and increase risks.
Innovation Solution
The use of an extension cannula with a flexible sock-like conduit and an in-line connector to deliver oxygenated blood directly to the thoracic aorta, enhancing blood flow to the brain and reducing perfusion injury to the kidneys, while also providing simple and effective access to the ECMO circuit for interventional equipment.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If peripheral VA-ECMO cannulation is used to provide circulatory support, then oxygenated blood flow is delivered to the arterial system, but kidney injury and vascular trauma occur due to high flow rates localized to the outlet region
Solution Approach 1:
The aorta is segmented into different regions for selective perfusion. The extension cannula divides the blood flow delivery by creating separate outlet ports: one directed toward the thoracic aorta for cerebral and coronary perfusion, and another toward the abdominal aorta for systemic perfusion. This segmentation allows high flow rates to be distributed to different anatomical regions rather than concentrated at a single outlet, reducing localized vascular trauma and kidney injury while maintaining overall productivity of oxygenated blood delivery.
2Productivity
If multiple large-bore cannulas are used to achieve high flow rates for systemic perfusion, then adequate oxygen delivery is maintained, but the risk of bleeding and vascular trauma increases
Solution Approach 1:
Multiple cannulation functions are merged into a single extension cannula device. The extension cannula integrates multiple outlet ports that can be directed toward different anatomical regions (thoracic aorta, abdominal aorta), combining what would traditionally require multiple separate cannulas into one device. This merging maintains the necessary systemic perfusion flow rate while reducing the number of vascular access sites, thereby decreasing the cumulative risk of bleeding and vascular trauma associated with multiple large-bore cannulas.
3Reliability
If peripherally cannulated VA-ECMO is used to support cardiopulmonary function, then circulatory support is provided, but pressure inside the heart and aorta increases causing ventricular wall stress and myocardial damage
Solution Approach 1:
The blood flow delivery is made non-uniform by directing different portions of the flow to different anatomical regions with different pressure requirements. The extension cannula creates localized perfusion zones: one outlet directed toward the thoracic aorta for high-pressure cerebral and coronary perfusion, and another toward the abdominal aorta for lower-pressure systemic perfusion. This local quality approach allows cardiopulmonary support to be maintained while reducing the uniform high pressure that would otherwise be applied throughout the entire aortic system, thereby decreasing ventricular wall stress and myocardial damage.
Data Source
AI summary
An extension cannula and in-line connector for use with a conventional ECMO return cannula is provided. The extension cannula includes a flexible conduit transitionable between a collapsed insertion state and an expanded deployed state when in communication with blow flow from an ECMO machine via the ECMO return cannula. The extension cannula may be positioned through a conventional ECMO return cannula such that the proximal end of the flexible conduit is disposed within and proximal to the end of the ECMO return cannula, while the distal end of the flexible conduit is disposed in a patient's thoracic aorta to deliver oxygenated blood directly to the patient's thoracic aorta via one or more pores at the distal region of the flexible conduit to improve cerebral oxygenation, maintain systemic arterial pulsatility, and reduce the potential for end-organ injury.