fitsCAN · Blood flow induced thrombosis and stenosis due to cannulation – an interdisciplinary study

In extracorporeal organ support (ECOS), one or more organ functions fail and are replaced by an artificial device. Kidney failure requires hemodialysis, at least until transplantation. Temporary lung- and/or heart-failure may be treated by Extracorporeal Membrane Oxygenation (ECMO). About 1.5 Million patients require hemodialysis worldwide. ECMO has an essential life-saving role during the ongoing COVID-19 pandemic, as during the Influenzae H1N1 pandemic in 2009. In ECOS, two or more accesses are used; one for blood drainage and another to return oxygenated blood. The flow rate in the cannula and the cannulated blood vessels is often significantly higher than physiologically experienced. The high flow velocity implies larger forces (stress) acting on the blood cells and the vessel walls. Thromboembolism and morphological and mechanical changes in the affected blood vessel are common complications in ECOS. This project focus on the impact of blood flow on these complications. Patient-specific data (CT, MRI and Ultrasound based) will be used to construct laboratory and simulation relevant frameworks. Set-ups for measurement of flow and mixing in-vitro will be used. Simulations will include modeling of transport of chemical species and blood cells along with modeling of platelet activation and risk for thrombus formation. The different tools will enable a considerably better understanding of the underlying pathological processes. The results will support further model development of these processes and facilitate improved cannulation techniques and new devices. These propositions are to be assessed by our clinical partners. Therefore, the project group includes, fluid mechanical expertise, and also clinical specialist in nephrology, intensive care/ECMO, and radiology. The outcome of research will enable device development and clinical decision-making reducing overall treatment complications.