{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:51:27Z","timestamp":1791568287399,"version":"4.3.4"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["ICMx"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) (VV-ECMO) and Veno-Artial Extracorporeal Membrane Oxygenation (VA-ECMO) have become evidence-based therapy options for patients with most severe heart and\/or lung failure. Cannulas continue to play a central role as the direct interface between patients and extracorporeal circulation. However, severe side-effects, such as coagulation and haemolysis, may result not only from a blood pump but also from inappropriate cannula design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on the multi-stage lighthouse design of a draining ECMO cannula, the area of the side holes was varied in both shape and size in the distal and proximal directions. Using a Computer-Aided Design (CAD)- Model of cannulas (19,21,23 French (Fr)) appropriate simulation models were created in the non-reactive plenum. The resultant numerical 3D simulations are based on physiological boundary conditions and on the flows covering different ECMO-flow rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The current cannula design reveals no-flow zones, which induce thrombus formation, especially when using blood-flow rates below 2 L\/min. New geometric cannula design variants revealed an improvement in pressure loss, but at the expense of pronounced no-flow zones in the distal region. During drainage, the largest proportion of the total volume flow drains through the proximal row of side holes. Here, the pressure and thus the flow for both, immediately drops to the level of the surrounding plenum. This means that risk areas for haemostasis develop more distally. The direct influence of the design is evident in the proximally exponentially reduced side holes. They significantly reduce the extent of the no-flow zones.<\/jats:p>\n                    <jats:p>Simulations of the reference cannula showed that suction to the vessel wall and thus closure of some side holes contributes to an overall improvement in flow within the cannula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When reducing the blood-flow rate in ECMO therapy, stagnation areas may develop within the drainage cannula. The geometry of the side holes has an important impact. A comparison of the different designs shows that distal growth of the side hole area results in improved flow behaviour.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40635-026-00980-8","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:21:09Z","timestamp":1791519669000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of side hole design of drainage cannulas on flow velocity and predilection sites for low-flow areas in veno-venous ECMO circuits"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9356-9775","authenticated-orcid":false,"given":"Markus","family":"Bongert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Marciniak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Windisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Karagiannidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"980_CR1","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","volume":"378","author":"A Combes","year":"2018","unstructured":"Combes A, Hajage D, Capellier G et al (2018) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 378:1965\u20131975","journal-title":"N Engl J Med"},{"key":"980_CR2","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s00134-023-07050-7","volume":"49","author":"G Grasselli","year":"2023","unstructured":"Grasselli G, Calfee CS, Camporota L et al (2023) ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med 49:727\u2013759","journal-title":"Intensive Care Med"},{"key":"980_CR3","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1097\/MAT.0000000000001510","volume":"67","author":"R Lorusso","year":"1992","unstructured":"Lorusso R, Shekar K, MacLaren G et al (1992) ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J 67:827\u2013844","journal-title":"ASAIO J"},{"key":"980_CR4","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/MAT.0000000000000377","volume":"62","author":"S Abdel-Sayed","year":"1992","unstructured":"Abdel-Sayed S, von Segesser L-K (1992) New dual lumen self-expanding catheter design requiring less suction. ASAIO J 62:427\u2013431","journal-title":"ASAIO J"},{"key":"980_CR5","doi-asserted-by":"publisher","first-page":"e22","DOI":"10.1097\/MAT.0000000000001412","volume":"68","author":"M Pi\u00f1\u00f3n","year":"1992","unstructured":"Pi\u00f1\u00f3n M, Su\u00e1rez J, Acu\u00f1a B et al (1992) Usefulness of self-expanding drainage cannula in venovenous extracorporeal membrane oxygenation: tips, tricks, and results of an early experience. ASAIO J 68:e22\u2013e26","journal-title":"ASAIO J"},{"key":"980_CR6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S1569-9293(02)00006-3","volume":"1","author":"XM Mueller","year":"2002","unstructured":"Mueller XM, Mallabiabrena I, Mucciolo G, von Segesser LK (2002) Optimized venous return with a self-expanding cannula: from computational fluid dynamics to clinical application. Interact Cardiovasc Thorac Surg 1:23\u201327","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"980_CR7","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.ejcts.2009.05.026","volume":"36","author":"LK von Segesser","year":"2009","unstructured":"von Segesser LK, Kalejs M, Ferrari E et al (2009) Superior flow for bridge to life with self-expanding venous cannulas. Europ J Cardiothorac Surg Offici J Europ Assoc Cardiothorac Surg 36:665\u2013669","journal-title":"Europ J Cardiothorac Surg Offici J Europ Assoc Cardiothorac Surg"},{"key":"980_CR8","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/978-88-470-5427-1_36","volume-title":"ECMO-extracorporeal life support in adults","author":"A Rubino","year":"2014","unstructured":"Rubino A, Haddon R, Corti F, Sangalli F (2014) Complications of extracorporeal support and their management. In: Sangalli F, Patroniti N, Pesenti A (eds) ECMO-extracorporeal life support in adults. Springer Milan, Milano, pp 415\u2013423"},{"key":"980_CR9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/978-88-470-5427-1_7","volume-title":"ECMO-extracorporeal life support in adults","author":"M Ranucci","year":"2014","unstructured":"Ranucci M (2014) Coagulation, anticoagulation, and inflammatory response. In: Sangalli F, Patroniti N, Pesenti A (eds) ECMO-extracorporeal life support in adults. Springer Milan, Milano, pp 77\u201390"},{"key":"980_CR10","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11175147","author":"S Rajsic","year":"2022","unstructured":"Rajsic S, Breitkopf R, Jadzic D, Popovic Krneta M, Tauber H, Treml B (2022) Anticoagulation strategies during extracorporeal membrane oxygenation: a narrative review. J Clin Med. https:\/\/doi.org\/10.3390\/jcm11175147","journal-title":"J Clin Med"},{"key":"980_CR11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s40635-019-0264-z","volume":"7","author":"KK Ki","year":"2019","unstructured":"Ki KK, Passmore MR, Chan CHH et al (2019) Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit. Intensive Care Med Exp 7:51","journal-title":"Intensive Care Med Exp"},{"key":"980_CR12","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1177\/0267659112468014","volume":"28","author":"K Kohler","year":"2013","unstructured":"Kohler K, Valchanov K, Nias G, Vuylsteke A (2013) ECMO cannula review. Perfusion 28:114\u2013124","journal-title":"Perfusion"},{"key":"980_CR13","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/854938","volume":"2012","author":"JY Park","year":"2012","unstructured":"Park JY (2012) The need of slanted side holes for venous cannulae. Comput Math Methods Med 2012:854938","journal-title":"Comput Math Methods Med"},{"key":"980_CR14","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/MAT.0000000000001440","volume":"68","author":"A Vatani","year":"1992","unstructured":"Vatani A, Liao S, Burrell AJC et al (1992) Improved drainage cannula design to reduce thrombosis in veno-arterial extracorporeal membrane oxygenation. ASAIO J 68:205\u2013213","journal-title":"ASAIO J"},{"key":"980_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2021.104484","volume":"134","author":"S Entezari","year":"2021","unstructured":"Entezari S, Shakiba A, Niazmand H (2021) Numerical investigation of the effects of cannula geometry on hydraulic blood flow to prevent the risk of thrombosis. Comput Biol Med 134:104484","journal-title":"Comput Biol Med"},{"key":"980_CR16","unstructured":"Broman LM. Clinical impact of cannulae design in VA-ECMO. Virtual Congress, 2021\u201305"},{"key":"980_CR17","doi-asserted-by":"crossref","unstructured":"Rauh P, Benk C, Beyersdorf F, Russe M (2020) Determination of local flow ratios and velocities in a femoral venous cannula with computational fluid dynamics and 4D flow-senitive magnetic resonance imaging: a method validation. Artif Organs: 1\u201310","DOI":"10.1111\/aor.13859"},{"key":"980_CR18","doi-asserted-by":"crossref","unstructured":"Fiusco F, Rorro F, Broman LM, Prahl Wittberg L (2022) Numerical and experimental investigation of a lighthouse tip drainage cannula used in extracorporeal membrane oxygenation. Artif Organs:1\u201312","DOI":"10.1111\/aor.14421"},{"key":"980_CR19","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/j.crad.2015.05.004","volume":"70","author":"DH Ballard","year":"2015","unstructured":"Ballard DH, Alexander JS, Weisman JA, Orchard MA, Williams JT, D\u2019Agostino HB (2015) Number and location of drainage catheter side holes: in vitro evaluation. Clin Radiol 70:974\u2013980","journal-title":"Clin Radiol"},{"key":"980_CR20","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1177\/0267659118782246","volume":"33","author":"T Goto","year":"2018","unstructured":"Goto T, Tanabe T, Inamura T et al (2018) Effect of inflow cannula side-hole number on drainage flow characteristics: flow dynamic analysis using numerical simulation. Perfusion 33:649\u2013655","journal-title":"Perfusion"},{"key":"980_CR21","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1007\/s13239-024-00770-x","volume":"16","author":"F Rorro","year":"2025","unstructured":"Rorro F, Broman LM, Prahl Wittberg L (2025) Performance comparison of centered and tilted blunt and lighthouse tip cannulae for drainage in extracorporeal life support. Cardiovasc Eng Technol 16:238\u2013250","journal-title":"Cardiovasc Eng Technol"},{"key":"980_CR22","unstructured":"Extracorporeal Life Support Organization (ELSO): Cannula Equipment List for the ELSO Registry Form: ELSO Registry Form Cannula List. Available at: www.elso.org\/registry\/supportdocuments\/cannulaequipmentlist.aspx. Accessed January 27, 2023."},{"key":"980_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2023.107772","volume":"168","author":"C Blum","year":"2024","unstructured":"Blum C, Steinseifer U, Neidlin M (2024) Systematic analysis of non-intrusive polynomial chaos expansion to determine rotary blood pump performance over the entire operating range. Comput Biol Med 168:107772","journal-title":"Comput Biol Med"},{"key":"980_CR24","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s10439-022-03105-w","volume":"51","author":"SV Ponnaluri","year":"2023","unstructured":"Ponnaluri SV, Hariharan P, Herbertson LH, Manning KB, Malinauskas RA, Craven BA (2023) Results of the interlaboratory computational fluid dynamics study of the FDA benchmark blood pump. Ann Biomed Eng 51:253\u2013269","journal-title":"Ann Biomed Eng"},{"key":"980_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2025.110137","volume":"191","author":"D Lin","year":"2025","unstructured":"Lin D, Kenjere\u0161 S (2025) Towards fast and reliable estimations of 3D pressure, velocity and wall shear stress in aortic blood flow: CFD-based machine learning approach. Comput Biol Med 191:110137","journal-title":"Comput Biol Med"},{"key":"980_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2025.111202","volume":"198","author":"F Dell'Agnello","year":"2025","unstructured":"Dell\u2019Agnello F, Capellini K, Gasparotti E et al (2025) Towards patient-specific hemodynamics of the aorta: a comprehensive CT-guided approach for moving boundary CFD simulations. Comput Biol Med 198:111202","journal-title":"Comput Biol Med"},{"key":"980_CR27","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1046\/j.1537-2995.1996.36196190516.x","volume":"36","author":"S Gregoretti","year":"1996","unstructured":"Gregoretti S (1996) Suction-induced hemolysis at various vacuum pressures: implications for intraoperative blood salvage. Transfusion 36:57\u201360","journal-title":"Transfusion"},{"key":"980_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-05121-9","volume":"28","author":"C Blum","year":"2024","unstructured":"Blum C, Landoll M, Strassmann SE, Steinseifer U, Neidlin M, Karagiannidis C (2024) Blood trauma in veno-venous extracorporeal membrane oxygenation: low pump pressures and low circuit resistance matter. Crit Care 28:330","journal-title":"Crit Care"},{"key":"980_CR29","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/RLI.0000000000000219","volume":"51","author":"M Markl","year":"2016","unstructured":"Markl M, Lee DC, Ng J, Carr M, Carr J, Goldberger JJ (2016) Left atrial 4D flow MRI: stasis and velocity mapping in patients with atrial fibrillation. Invest Radiol 51:147\u2013154","journal-title":"Invest Radiol"},{"key":"980_CR30","unstructured":"Maquet Getinge Group: designed to enable otpimal extra-corporeal life support - from single to bi-caval dual lumen catheter, 06 \/ 2012."},{"key":"980_CR31","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1177\/0267659119830514","volume":"34","author":"LM Broman","year":"2019","unstructured":"Broman LM, Prahl Wittberg L, Westlund CJ et al (2019) Pressure and flow properties of cannulae for extracorporeal membrane oxygenation part II: drainage (venous) cannulae. Perfusion 34:65\u201373","journal-title":"Perfusion"},{"key":"980_CR32","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1253\/jcj.39.143","volume":"39","author":"H Ijima","year":"1975","unstructured":"Ijima H, Satoh I, Hori M (1975) Blood flow of the superior and inferior venae cavae in cardiogenic shock: a study with an emphasis of the role of the stretch receptors in the low pressure system. Jpn Circ J 39:143\u2013149","journal-title":"Jpn Circ J"},{"key":"980_CR33","doi-asserted-by":"publisher","first-page":"349","DOI":"10.3233\/CH-1983-3401","volume":"3","author":"H-D Papenfuss","year":"1983","unstructured":"Papenfuss H-D, Gross JF (1983) Interaction between hemofiltration and hemorheology in hollow-fiber artificial kidneys. Clin Hemorheol Microcirc 3:349\u2013365","journal-title":"Clin Hemorheol Microcirc"},{"key":"980_CR34","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1152\/jappl.1965.20.5.954","volume":"20","author":"EW Merrill","year":"1965","unstructured":"Merrill EW, Benis AM, Gilliland ER, Sherwood TK, Salzman EW (1965) Pressure-flow relations of human blood in hollow fibers at low flow rates. J Appl Physiol 20:954\u2013967","journal-title":"J Appl Physiol"},{"key":"980_CR35","volume-title":"Medizinische Verfahrenstechnik, Ausgew\u00e4hlte Themen aus der Biofluidmechanik","author":"HD Papenfuss","year":"2004","unstructured":"Papenfuss HD (2004) Medizinische Verfahrenstechnik, Ausgew\u00e4hlte Themen aus der Biofluidmechanik. Ruhr-Universit\u00e4t Bochum"},{"key":"980_CR36","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.2514\/3.12149","volume":"32","author":"FR Menter","year":"1994","unstructured":"Menter FR (1994) Two-equation eddy-viscosity turbulence models for engineering applications. AIAA J 32:1598\u20131605","journal-title":"AIAA J"}],"container-title":["Intensive Care Medicine Experimental"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00980-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40635-026-00980-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00980-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:03:26Z","timestamp":1791565406000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40635-026-00980-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["980"],"URL":"https:\/\/doi.org\/10.1186\/s40635-026-00980-8","relation":{},"ISSN":["2197-425X"],"issn-type":[{"value":"2197-425X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"assertion":[{"value":"25 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"M. Bongert is one of the inventors of a novel drainage cannula based on the proximal surface reduction of the side holes from Chinabridge Medical Technology Co., LTD, Shenzen, China, which is the patent holder. All other authors have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"130"}}