{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T18:31:00Z","timestamp":1785868260851,"version":"3.56.0"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["ERC CoG 2021: Project 101045453\u2014fitsCAN"],"award-info":[{"award-number":["ERC CoG 2021: Project 101045453\u2014fitsCAN"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2022-06725"],"award-info":[{"award-number":["2022-06725"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Venovenous extracorporeal membrane oxygenation (VV ECMO) can be performed with different cannulation approaches: femoro-femoral (FF), femoro-jugular (FJ), or jugulo-femoral (JF), all characterized by one drainage cannula. Dual drainage cannulation (JFF, with two drainage cannulae) may be considered in refractory hypoxemia. This work compared single vs. dual drainage concerning the impact on hemodynamics and oxygenation performance by studying the drainage ratio between the jugular and femoral cannulae, their type and position. Computational fluid dynamics was used in a patient-averaged model of the right atrium (RA) and central veins to estimate recirculation fraction (R\n \n \n \n \n \n \n \u2000<\/mml:mo>\n \n f<\/mml:mi>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ), arterial oxygen saturation (SaO\n \n \n \n \n \n \n \u2000<\/mml:mo>\n \n \n 2<\/mml:mn>\n <\/mml:mrow>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ), caval pressures, shear rates, time-averaged wall shear stress (TAWSS), and stagnation volume in each cannulation configuration. An ECMO flow rate of 4 L\/min and cardiac output of 6 L\/min were considered. JF showed the highest R\n \n \n \n \n \n \n \u2000<\/mml:mo>\n \n f<\/mml:mi>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n (22%) and the lowest SaO\n \n \n \n \n \n \n \u2000<\/mml:mo>\n \n \n 2<\/mml:mn>\n <\/mml:mrow>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n (80%). The lowest R\n \n \n \n \n \n \n \u2000<\/mml:mo>\n \n f<\/mml:mi>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n (0.03%) and the highest SaO\n \n \n \n \n \n \n \u2000<\/mml:mo>\n \n \n 2<\/mml:mn>\n <\/mml:mrow>\n <\/mml:mrow>\n <\/mml:msub>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n (90%) were obtained in JFF with a multistage jugular cannula draining at a flow rate lower than the native venous inflow. FF presented the lowest pressure in the inferior vena cava (IVC, \u221210 mmHg), but the highest in the superior vena cava (SVC, 32 mmHg) when the return cannula tip was placed at the superior cavo-atrial junction. The stagnation volume was highest in JFF at femoral drainage \u22642 L\/min. In most configurations the maximum TAWSS in the RA and SVC were more than 5 times higher than no ECMO (baseline). Adding an additional drainage cannula may in some cases improve oxygenation compared to standard single drainage configurations. The efficiency of JFF was mainly influenced by the jugular\/femoral drainage ratio, cannula type and position in the SVC. Significant differences in caval pressures and TAWSS were observed between the configurations. The optimal choice of cannulation would be patient-tailored, considering specific needs and complication risks.\n <\/jats:p>","DOI":"10.1371\/journal.pone.0354915","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:37:58Z","timestamp":1785865078000},"page":"e0354915","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficiency and hemodynamics of dual drainage venovenous ECMO: A computational parametric study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7160-5387","authenticated-orcid":true,"given":"Monica","family":"Emendi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"H\u00f6rwing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5409-8280","authenticated-orcid":true,"given":"Louis","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Svensson Marcial","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torkel","family":"Brismar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Mikael","family":"Broman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Prahl Wittberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"issue":"2","key":"pone.0354915.ref001","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/MAT.0000000000000179","article-title":"Recirculation in venovenous extracorporeal membrane oxygenation","volume":"61","author":"D Abrams","year":"2015","journal-title":"ASAIO J"},{"issue":"12","key":"pone.0354915.ref002","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.3390\/medicina60121936","article-title":"Recirculation in Veno-Venous Extracorporeal Membrane Oxygenation","volume":"60","author":"V Gagliardi","year":"2024","journal-title":"Medicina (Kaunas)"},{"key":"pone.0354915.ref003","volume-title":"Extracorporeal Life Support Organization 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Chabry","year":"2018","journal-title":"BJSTR"},{"issue":"11","key":"pone.0354915.ref025","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s00134-015-3779-0","article-title":"Molding thrombus of an ECMO cannula floating in the right atrium","volume":"41","author":"P Morimont","year":"2015","journal-title":"Intensive Care Med"},{"issue":"4","key":"pone.0354915.ref026","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.hrtlng.2018.03.011","article-title":"Chugging in patients on veno-venous extracorporeal membrane oxygenation: An under-recognized driver of intravenous fluid administration in patients with acute respiratory distress syndrome?","volume":"47","author":"JM Walter","year":"2018","journal-title":"Heart Lung"},{"key":"pone.0354915.ref027","doi-asserted-by":"crossref","DOI":"10.21037\/jtd.2019.04.81","article-title":"Bedside troubleshooting during venovenous extracorporeal membrane oxygenation (ECMO)","volume":"11","author":"B Patel","year":"2019","journal-title":"J Thorac Dis"},{"issue":"1","key":"pone.0354915.ref028","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s13613-018-0439-x","article-title":"Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney","volume":"8","author":"X Chen","year":"2018","journal-title":"Ann Intensive Care"},{"issue":"4","key":"pone.0354915.ref029","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1038\/s41440-023-01512-7","article-title":"Renal venous hypertension to the regulation of pressure natriuresis in heart failure","volume":"47","author":"T Mori","year":"2024","journal-title":"Hypertens Res"},{"issue":"5","key":"pone.0354915.ref030","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1152\/japplphysiol.00649.2021","article-title":"Impact of altered vena cava flow rates on right atrium flow characteristics","volume":"132","author":"LP Parker","year":"2022","journal-title":"J Appl Physiol (1985)"},{"issue":"6","key":"pone.0354915.ref031","doi-asserted-by":"crossref","DOI":"10.1063\/5.0212546","article-title":"Venovenous extracorporeal membrane oxygenation drainage cannula performance: From generalized to patient-averaged vessel model","volume":"36","author":"LP Parker","year":"2024","journal-title":"Physics of Fluids"},{"issue":"6","key":"pone.0354915.ref032","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1007\/BF01522036","article-title":"Rheology of concentrated disperse systems II. A model for non-newtonian shear viscosity in steady flows","volume":"17","author":"D Quemada","year":"1978","journal-title":"Rheol Acta"},{"issue":"4","key":"pone.0354915.ref033","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s10237-024-01840-8","article-title":"A continuum model for the elongation and orientation of Von Willebrand factor with applications in arterial flow","volume":"23","author":"EF Yeo","year":"2024","journal-title":"Biomech Model Mechanobiol"},{"key":"pone.0354915.ref034","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/s12938-016-0262-2","article-title":"Numerical prediction of thrombus risk in an anatomically dilated left ventricle: the effect of inflow cannula designs","volume":"15","author":"S Liao","year":"2016","journal-title":"Biomed Eng Online"},{"issue":"1","key":"pone.0354915.ref035","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13054-018-2083-0","article-title":"Position of draining venous cannula in 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patients\u2019 fluid balance in venovenous extracorporeal membrane oxygenation: A historical cohort study","volume":"40","author":"S Thiara","year":"2025","journal-title":"Perfusion"},{"key":"pone.0354915.ref039","doi-asserted-by":"crossref","first-page":"973240","DOI":"10.3389\/fmed.2022.973240","article-title":"Recirculation in single lumen cannula venovenous extracorporeal membrane oxygenation: A non-randomized bi-centric trial","volume":"9","author":"C Fisser","year":"2022","journal-title":"Front Med (Lausanne)"},{"issue":"7","key":"pone.0354915.ref040","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1097\/MAT.0000000000000917","article-title":"Large Dual-Lumen Extracorporeal Membrane Oxygenation Cannulas Are Associated with More Intracranial Hemorrhage","volume":"65","author":"M Mazzeffi","year":"2019","journal-title":"ASAIO J"},{"issue":"2","key":"pone.0354915.ref041","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s12055-021-01293-z","article-title":"A rare case of superior vena cava syndrome in a patient on VV-ECMO","volume":"38","author":"R Rajavardhan","year":"2022","journal-title":"Indian J Thorac Cardiovasc Surg"},{"key":"pone.0354915.ref042","doi-asserted-by":"crossref","first-page":"110898","DOI":"10.1016\/j.jbiomech.2021.110898","article-title":"Discrete responses of erythrocytes, platelets, and von Willebrand factor to shear","volume":"130","author":"CHH Chan","year":"2022","journal-title":"J Biomech"},{"issue":"4","key":"pone.0354915.ref043","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.jvs.2014.12.050","article-title":"Role of high shear rate in thrombosis","volume":"61","author":"LDC Casa","year":"2015","journal-title":"J Vasc Surg"},{"issue":"8","key":"pone.0354915.ref044","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1161\/01.ATV.0000229658.76797.30","article-title":"Flow effects on coagulation and thrombosis","volume":"26","author":"JJ 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