Expandable ECMO Extension Cannula for Aortic Perfusion
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Solution Overview
Problem
Current VA-ECMO systems cause complications such as kidney injury, stroke, and vascular trauma due to high arterial pressure and non-pulsatile flow, leading to increased mortality and morbidity, and existing solutions like central cannulation require invasive surgery or additional vascular punctures.
Innovation Solution
An extension cannula system that includes a flexible, self-expanding conduit and an in-line connector to deliver oxygenated blood directly to the thoracic aorta, reducing the need for additional vascular access and minimizing perfusion injury by maintaining systemic arterial pulsatility and enhancing blood flow to the brain and kidneys.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If peripherally cannulated VA-ECMO is used to provide circulatory and gas exchange support, then oxygenated blood flow is delivered to the arterial system, but kidney injury, stroke risk, and vascular trauma increase due to high arterial pressure and non-pulsatile flow
Solution Approach 1:
The patent introduces an extension cannula as an intermediary component between the ECMO return cannula and the aorta. This extension cannula has multiple outlets positioned at different locations along its length, allowing oxygenated blood to be delivered to multiple arterial territories simultaneously. The extension cannula acts as a mediator that distributes blood flow more evenly, reducing the harmful effects of high pressure and non-pulsatile flow on specific organs like the kidneys while maintaining overall circulatory support
Solution Approach 2:
The extension cannula is divided into multiple segments or outlets along its length, with each outlet capable of delivering blood to different arterial branches. This segmentation allows the single ECMO system to perfuse multiple organ systems simultaneously, reducing the concentration of high-pressure flow on any single organ and thereby reducing the risk of kidney injury and stroke
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, vascular trauma, and acute limb ischemia increases
Solution Approach 1:
The extension cannula is segmented into multiple outlets that can be positioned to deliver blood to different arterial territories. This allows a single cannula insertion to achieve the blood flow rates of multiple cannulas while reducing vascular trauma. The multiple outlets distribute the total flow demand across several smaller ejection sites, reducing the burden on any single vascular access site and thereby reducing the risk of bleeding and vascular trauma
Solution Approach 2:
The extension cannula extends the blood delivery function from a single-point return (conventional cannula) to a distributed multi-point return system. By adding the spatial dimension of multiple outlets at different positions along the cannula length, the system achieves higher effective flow distribution without requiring multiple separate cannula insertions, thus maintaining productivity while reducing the harmful effects of multiple large-bore cannulas
3Productivity
If peripherally cannulated VA-ECMO pressurizes the entire aorta to deliver oxygenated blood, then systemic perfusion is achieved, but ventricular wall stress and myocardial oxygen consumption increase, expanding myocardial damage
Solution Approach 1:
The extension cannula serves as an intermediary that intercepts oxygenated blood from the ECMO system and redistributes it to multiple arterial territories before the blood reaches the ventricles. By positioning outlets at strategic locations along the aorta, the extension cannula delivers oxygenated blood directly to systemic circulation, bypassing the need for the ventricles to generate high pressure, thereby reducing ventricular wall stress and myocardial oxygen consumption while maintaining systemic perfusion
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The extension cannula system improves cerebral oxygenation, reduces the risk of ischemic stroke and kidney injury, and decreases cardiac workload, thereby lowering mortality and morbidity associated with VA-ECMO use.
Implementation Method 1
the expandable conduit transitions from a compressed delivery state to an expanded operational state
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.