{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:52:45Z","timestamp":1791006765249,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limb ischaemia remains a common complication of peripheral venoarterial extracorporeal membrane oxygenation (VA\u2010ECMO). Reinforced introducer sheaths are commonly used off\u2010label as distal perfusion cannulas; however, their ability to provide adequate distal flow across clinically relevant ECMO configurations remains uncertain. We sought to evaluate the influence of cannula size configurations on distal flow fraction using a simple mock circulatory loop.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Distal flow fraction was evaluated across 24 configurations comprising 15\u201321Fr arterial return cannulas and 7\u20139Fr reinforced introducer sheaths. Direct and indirect connection of the DPC to the arterial return cannula was compared. Measurements were obtained at circuit flows from 1 to 5\u2009L\/min in 100\u2009mL\/min increments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Distal flow fraction significantly decreased with increasing arterial return cannula size (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.796 percentage points; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , \u22120.844 to \u22120.748;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and indirect\n                      <jats:styled-content style=\"fixed-case\">DPC<\/jats:styled-content>\n                      connection (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.475 percentage points; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , \u22120.588 to \u22120.362;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In comparison, increasing\n                      <jats:styled-content style=\"fixed-case\">DPC<\/jats:styled-content>\n                      size was overall associated with a small and insignificant augmentation of the distal flow fraction (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      +0.098 percentage points per Fr; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      \u22120.014 to +0.210;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.087). At the lowest circuit flow (1\u2009L\/min), the maximum distal flow achieved by any configuration was 86\u2009\n                      <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\n                      \/min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this controlled hydraulic experiment, larger arterial return cannulas reduced DPC flow relative to total circuit flow. Distal flow was particularly limited at low total circuit flows, potentially compromising limb perfusion during ECMO weaning. These findings support further investigation to evaluate the appropriateness of introducer sheath devices for the purposes of distal limb protection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.70250","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:00:51Z","timestamp":1791003651000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cannula Pairing Determines Distal Limb Perfusion During Peripheral Veno\u2010Arterial Extracorporeal Membrane Oxygenation: An Experimental Mock\u2010Loop Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1824-9870","authenticated-orcid":false,"given":"Elliott","family":"Worku","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Sydney  Sydney New South Wales Australia"},{"name":"Intensive Care Service Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9519-7614","authenticated-orcid":false,"given":"Richard","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, School of Biomedical Engineering University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruaidhri","family":"Carey","sequence":"additional","affiliation":[{"name":"Intensive Care Service Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Kyme","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, School of Biomedical Engineering University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0661-8610","authenticated-orcid":false,"given":"Timothy","family":"Southwood","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Sydney  Sydney New South Wales Australia"},{"name":"Intensive Care Service Royal Prince Alfred Hospital  Sydney New South Wales 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