Jutta Arens

University of Twente | UT · Department of Biomechanical Engineering

Computational fluid dynamics (CFD) is used to simulate blood flow inside the fiber bundles of oxygenators. The results are interpreted in terms of flow distribution, e.g., stagnation and shunt areas. However, experimental measurements that provide such information on the local flow between the fibers are missing. A transparent model of an oxygenato...

Einleitung: Extrakorporale Membranoxygenierung (ECMO) kann den Gasaustausch bei terminalem Lungenversagen übernehmen. Die Entwicklung eines implantierbaren Lungenunterstützungssystems wurde bislang durch eingeschränkte Hämokompatibilität, die Aktivierung der Gerinnung sowie des Komplementsystems, durch Plasma Leakage und Proteinablagerungen mit k...

Oxygenators have been used in neonatal extracorporeal membrane oxygenation (ECMO) since the 1970s. The need to develop a more effective oxygenator for this patient cohort exists due to their size and blood volume limitations. This study sought to validate the next design iteration of a novel oxygenator for neonatal ECMO with an integrated pulsatile...

Abstract The ultimate objective of university research and development projects is usually to create knowledge, but also to successfully transfer results to industry for subsequent marketing. We hypothesized that the university technology transfer requires efficient measures to improve this important step. Besides good scientific practice, foresigh...

Gas exchange in premature neonates is regularly impaired by structural and functional immaturity of the lung. Mechanical ventilation, which is vitally important to sustain oxygenation and CO(2) elimination, causes, at the same time, mechanical and inflammatory destruction of lung tissue. To date, extracorporeal oxygenation is not a treatment option...

Machine perfused ex-vivo organs offer an excellent experimental platform, e.g., for studying organ physiology and for conducting pre-clinical trials for drug delivery. One main challenge in machine perfusion is the accurate assessment of organ condition. Assessment is often performed using viability markers, i.e., lactate concentrations and blood g...

Objective Hypertrophic obstructive cardiomyopathy (HOCM) develops in at least 1 out of 715 young adults. Patients who are refractory to medical therapy qualify for septal myectomy. Due to anatomy, serious complications such as ventricular septal defect and heart block may occur. Establishing cardiovascular magnetic resonance (CMR)–based 3-dimension...

Combined extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) pose complex hemodynamic challenges in intensive care. In this study, a comprehensive lumped parameter model (LPM) is developed to simulate the cardiovascular system, incorporating ECMO and CRRT circuit dynamics. The model is used to analyze nine CRR...

More than 13 million children are born preterm annually. Prematurity-related mortality accounts for 0.9 million deaths worldwide. The majority of those affected are Extremely Preterm Infants (gestational age less than 28 weeks). Immaturity causes organ failure and specific morbidities like germinal matrix hemorrhage, bronchopulmonary dysplasia, and...

Oxygenators take over lung function in the event of severe lung injuries by exchanging gas into the blood stream using hollow fiber membrane mats. A central limitation of oxygenators is their large foreign surface area and priming volume, which cause blood damage. Thus, gas exchange efficiency needs to be improved through an understanding of the in...

Intravascular surgical instruments require precise navigation within narrow vessels, necessitating maximum flexibility, minimal diameter, and high degrees of freedom. Existing tools often lack control during insertion due to undesirable bending, limiting vessel accessibility and risking tissue damage. Next-generation instruments aim to develop hemo...

Extracorporeal membrane oxygenation (ECMO) is a temporary lifesaving treatment for critically ill patients with severe respiratory or cardiac failure. Studies demonstrated the feasibility of in-hospital mobilizing during and after ECMO treatment preventing neuromuscular weakness and impaired physical functioning. Despite more compact mobile ECMO de...

Many membrane oxygenator patients suffer from renal disfunction. For these patients, a novel device integrating artificial lung and kidney support is being developed. Although outside-in blood flow is standard for membrane oxygenators, this is not typical for hemodialysis systems. The effect of outside-in blood flow on the efficiency of hemodialysi...

Intravascular surgical instruments necessitate precise navigation within narrow vessels, requiring maximum flexibility, minimal diameter, and high degrees of freedom. However, existing tools often lack adequate control during insertion due to undesirable bending, which not only limits vessel accessibility but also poses a risk of tissue damage. The...

One approach to the wireless actuation and gravity compensation of untethered helical magnetic devices (UHMD) is through swimming with a non-zero angle of attack (AoA). This configuration allows us to counteract gravity, so that for a given desired path, we can move the UHMD controllably without drifting downward under its own weight. This study se...

Refurbishing single use extracorporeal membrane oxygenation (ECMO) oxygenators for in vitro research applications is common. However, the refurbishment protocols that are established in respective laboratories have never been evaluated. In the present study, we aim at proving the relevance of a well-designed refurbishing protocol by quantifying the...

With great interest we read the systematic review and meta-analysis by Osborne et al. on the effectiveness of high- and low-fidelity simulation-based medical education in teaching cardiac auscultation [1]. We congratulate the authors for their efforts to provide a systematic review on simulation-based education. While the authors conclude that hig...

Artificial membrane lungs are composed of hollow fiber membranes. Blood flows with low velocities in the membrane bundle, forming a laminar boundary layer near the membrane surfaces that limits gas transfer. Passive blood mixing within the fiber array is utilized to overcome this limitation. Nevertheless, it is unclear to which extent blood mixing...

The overall survival rate of extracorporeal life support (ECLS) remains at 60%. Research and development has been slow, in part due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator (“RatOx”) and presents preliminary in vitro classification tests. The RatOx has an adaptable fiber module size...

High-volume extracorporeal membrane oxygenation (ECMO) centers generally have better outcomes than (new) low-volume ECMO centers, most likely achieved by a suitable exposure to ECMO cases. To achieve a higher level of training, simulation-based training (SBT) offers an additional option for education and extended clinical skills. SBT could also hel...

The survival rate of extracorporeal life support (ECLS) remains overall at 60 %. Research and development is slow, partly due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator (“RatOx”) and shows preliminary in vitro classification tests. The RatOx has an adaptable fiber module size for vari...

When returning blood to the pulmonary artery (PA), the inflow jet interferes with local hemodynamics. We investigated the consequences for several connection scenarios using transient computational fluid dynamics simulations. The PA was derived from CT data. Three aspects were varied: graft flow rate, anastomosis location, and inflow jet path lengt...

Background: Extracorporeal membrane oxygenation (ECMO) became an accepted therapy for the treatment of severe acute respiratory distress syndrome and chronic obstructive pulmonary disease. However, ECMO systems are still prone to thrombus formation and decrease of gas exchange over time. Therefore, it is necessary to conduct qualified studies to i...

In vitro thrombogenicity tests for rotary blood pumps (RBPs) could benefit from assessing coagulation kinematics, as RBP design improves. In this feasibility study, we investigated if the method of thromboelastometry (TEM) is able to assess coagulation kinematics under the in vitro conditions of RBP tests. We conducted in vitro thrombogenicity test...

Untethered helical magnetic devices (UHMDs) have the potential to navigate bodily fluids using permanentmagnet robotic systems for minimally invasive diagnostic and surgical procedures. These devices can be actuated by robotically moving rotating permanent magnets (RPMs) to achieve controllable steering and propulsion simultaneously in a wireless m...

Introduction: Patients undergoing extracorporeal membrane oxygenation (ECMO) are at high risk of acute kidney injury and fluid overload. Up to 70% of ECMO patients suffer from AKI and half of them will require an additional renal replacement therapy. In the clinical setting, continuous renal replacement therapy (CRRT) is applied to provide renal s...

Extracorporeal membrane oxygenation (ECMO) provides pulmonary and/or cardiac support for critically ill patients. Due to their diseases, they are at high risk of developing acute kidney injury. In that case, continuous renal replacement therapy (CRRT) is applied to provide renal support and fluid management. The ECMO and CRRT circuits can be combin...

Membrane lungs consist of thousands of hollow fiber membranes packed together as a bundle. The devices often suffer from complications because of non-uniform flow through the membrane bundle, including regions of both excessively high flow and stagnant flow. Here, we present a proof-of-concept design for a membrane lung containing a membrane module...

Extracorporeal membrane oxygenation (ECMO) is an established rescue therapy for patients with chronic respiratory failure waiting for lung transplantation (LTx). The therapy inherent immobilization may result in fatigue, consecutive deteriorated prognosis, and even lost eligibility for transplantation. We conducted a feasibility study on a novel sy...

Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths globally. The currently available therapy options are normobaric oxygen (NBO) and hyperbaric oxygen (HBO). While NBO lacks in efficacy, HBO is not available in all areas and countries. We present a novel method, extracorporeal hyperoxygenation therapy (EHT), for the tre...

Background The major obstacle of blood-contacting medical devices is insufficient hemocompatibility, particularly thrombogenicity and platelet activation. Pre-clinical in-vitro testing allows for the evaluation of adverse thrombogenicity-related events, but is limited, among others, by the availability and quantity of human blood donations. The use...

Extracorporeal membrane oxygenation (ECMO) is an established rescue therapy for patients with chronic respiratory failure waiting for lung transplantation (LTx). The therapy inherent immobilization may result in fatigue, consecutive deteriorated prognosis and even lost eligibility for transplantation. We conducted a feasibility study on a novel sys...

Background: Membranes based on triply periodic minimal surfaces (TPMS) have proven a superior gas transfer compared to the contemporary hollow fiber membrane design in artificial lungs. The improved oxygen transfer is attributed to disrupting the laminar boundary layer adjacent to the membrane surface known as main limiting factor to mass transpor...

Purpose Extracorporeal membrane oxygenation has gained increasing attention in the treatment of patients with acute and chronic cardiopulmonary and respiratory failure. However, clotting within the oxygenators or other components of the extracorporeal circuit remains a major complication that necessitates at least a device exchange and bears risks...

The use of extracorporeal life support (ECLS) devices has significantly increased in the last decades. Despite medical and technological advancements, a main challenge in the ECLS field remains the complex interaction between the human body, blood, and artificial materials. Indeed, blood exposure to artificial surfaces generates an unbalanced activ...

Background and objectives: Carbon monoxide (CO) inhalation is the leading cause of poison-related deaths in the United States. CO binds to hemoglobin (Hb), displaces oxygen, and reduces oxygen delivery to tissues. The optimal treatment for CO poisoning in patients with normal lung function is the administration of hyperbaric oxygen (HBO). However,...

Additive manufacturing of complex porous polymer geometries is a new field of advanced materials processing. Such new geometries can be used to fabricate porous polymer monoliths serving as a support for other material functions. Here, a novel fabrication technology to manufacture tailored 3D porous monoliths via additive manufacturing and templati...

Currently, artificial-membrane lungs consist of thousands of hollow fiber membranes where blood flows around the fibers and gas flows inside the fibers, achieving diffusive gas exchange. At both ends of the fibers, the interspaces between the hollow fiber membranes and the plastic housing are filled with glue to separate the gas from the blood phas...

State of the art artificial membrane lungs incorporate hollow fiber membranes. The creeping blood flow in hollow fiber bundles forms a boundary layer that represents a diffusive resistance to gas transfer. Advances in additive manufacturing allow for the fabrication of novel membrane designs that overcome this limitation. The goal of this study is...

Thrombosis is a potentially life-threatening complication in veno-arterial extracorporeal membrane oxygenation (ECMO) circuits, which may originate from the drainage cannula due to unfavorable blood flow dynamics. This study aims to numerically investigate the effect of cannula design parameters on local fluid dynamics, and thus thrombosis potentia...

The hemocompatibility of blood-contacting medical devices remains one of the major challenges in medical device development. A common tool for the analysis of adherent and activated platelets on materials following in vitro tests is microscopy. Currently, most researchers develop their own routines, resulting in numerous different methods that are...

The hemocompatibility of blood-contacting medical devices remains one of the major challenges in biomedical engineering and makes research in the field of new and improved materials inevitable. However, current in-vitro test and analysis methods are still lacking standardization and comparability, which impedes advances in material design. For exam...

The hemocompatibility of blood-contacting medical devices remains one of the major challenges in biomedical engineering and makes research in the field of new and improved materials inevitable. However, current in-vitro test and analysis methods are still lacking standardization and comparability, which impedes advances in material design. For exam...

PurposeCurrently used cannulae for extracorporeal carbon dioxide removal (ECCO2R) are associated with complications such as thrombosis and distal limb ischemia, especially for long-term use. We hypothesize that the risk of these complications is reducible by attaching hemodynamically optimized grafts to the patient’s vessels. In this study, as a fi...

Background RESP score and PRESERVE score have been validated for veno-venous Extracorporeal Membrane Oxygenation in severe ARDS to assume individual mortality risk. ARDS patients with low-flow Extracorporeal Carbon Dioxide Removal, especially pumpless Extracorporeal Lung Assist, have also a high mortality rate, but there are no validated specific o...

Only a very small portion of end-stage organ failures can be treated by transplantation because of the shortage of donor organs. Although artificial long-term organ support such as ventricular assist devices provide therapeutic options serving as a bridge-to-transplantation or destination therapy for end-stage heart failure, suitable long-term arti...

The aim of this work is to establish a large volume batch production system to produce sufficient volumes of ghost cells to facilitate hemolysis testing of mechanical circulatory support devices. A volume of more than 405 mL with a hematocrit of at least 28 % is required to perform in‐vitro hemolysis testing of mechanical circulatory support device...

Background: Extracorporeal carbon dioxide removal (ECCO2R) uses an extracorporeal circuit to directly remove carbon dioxide from the blood either in lieu of mechanical ventilation or in combination with it. While the potential benefits of the technology are leading to increasing use, there are very real risks associated with it. Several studies de...

Although the hemocompatibility of left-ventricular assist devices (LVADs) has continuously improved, assessment of hemolysis remains mandatory in pre-clinical testing. The ASTM-F1841 has standardized this assessment since 1997. However, the recommended usage of fresh, non-pooled human blood is hardly feasible with the test loop volume specified the...

Wearable extracorporeal membrane oxygenation (ECMO) circuits may soon become a viable alternative to conventional ECMO treatment. Common device-induced complications, however, such as blood trauma and oxygenator thrombosis, must first be addressed to improve long-term reliability, since ambulatory patients cannot be monitored as closely as intensiv...

Passively levitated ventricular assist devices (VADs) are vulnerable to impeller‐housing contact and could benefit from surface coatings that improve wear resistance. Such coatings can be manufactured by plasma‐electrolytic oxidation (PEO), but their suitability for blood‐contact applications need further investigation. We therefore compared blood‐...

Calcification is a major reason for the failure of bioprosthetic heart valves. Therefore, several attempts towards an accelerated in vitro model were undertaken in order to provide a cost- and time-saving method for the analysis of calcification processes. Due to the problem of superficial or spontaneous precipitation, which occurred in the fluids...

Discussion 4 The derived computational model is simple but it shows basic characteristics of LAP 0 estimation from intrinsically measured EDV and Td at unknown venous compliance. The venous compliance has no significant influence on LAP 0 values extracted from EDV and Td, except at very low values. The uncertainty in the extracted LAP 0 is particul...

A physiological control of a total artificial heart (TAH) requires reliable information on left arterial pressure (LAP). When LAP is derived indirectly from intrinsic TAH parameters like end diastolic volume (EDV) and diastole duration (Td), the transfer function and associated uncertainties need to be well understood.We derived a computational equ...

Children with end-stage lung failure awaiting lung transplant would benefit from improvements in artificial lung technology allowing for wearable pulmonary support as a bridge-to-transplant therapy. In this work, we designed, fabricated, and tested the Pediatric MLung-a dual-inlet hollow fiber artificial lung based on concentric gating, which has a...

The most common technical complication during ECMO is clot formation. A large clot inside a membrane oxygenator reduces effective membrane surface area and therefore gas transfer capabilities, and restricts blood flow through the device, resulting in an increased membrane oxygenator pressure drop (dpMO). The reasons for thrombotic events are manifo...

Under physiological conditions, up to 97% of the oxygen in blood that is transported from lungs to tissue is bound to hemoglobin. To predict oxygen transfer in artificial lungs on a membrane fiber level with computational fluid dynamics (CFD), previous investigators have incorporated the hemoglobin‐oxygen interaction into an effective diffusivity c...

This research was presented at the ASAIO 2018: Clot sizes and positions are well documented in literature for the Maquet Quadrox-i Adult oxygenator based on CT data extracted from devices after patient treatment. Based on this data, the present study was designed to investigate the effects of large clots on purely technical parameters, for example,...

Particle image velocimetry (PIV) is a commonly used method for in vitro investigation of fluid dynamics in biomedical devices, such as flow diverters for intracranial aneurysm treatment. Since it is limited to transparent blood substituting fluids like water-glycerol mixture, the influence of coagulation and platelet aggregation is neglected. We ai...

The hydrodynamic flow resistance at low Reynolds numbers through hollow fiber membrane bundles is modeled, e.g. for computational fluid dynamics (CFD), as Darcy permeability K following the porous media approach. Experimental determination of the permeability of a particular hollow fiber bundle arrangement (fiber angle, diameter, and distance) is l...