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In Vitro Hemodynamic Evaluation of an Adult Pulsatile Extracorporeal Membrane Oxygenation System
Author(s) -
Wang Shigang,
Moroi Morgan,
Brehm Christoph E.,
Kunselman Allen R.,
Ündar Akif
Publication year - 2018
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13156
Subject(s) - pulsatile flow , oxygenator , hemodynamics , cannula , peristaltic pump , extracorporeal membrane oxygenation , hematocrit , membrane oxygenator , medicine , anesthesia , cardiology , biomedical engineering , cardiopulmonary bypass , surgery , physics , meteorology
The objective of this study was to evaluate a pulsatile extracorporeal membrane oxygenation (ECMO) system in terms of hemodynamic energy generation and transmission under various pulsatile amplitudes, flow rates, and pseudopatient pressures in a simulated adult ECMO circuit. Surplus hemodynamic energy (SHE), a measure of the quality of pulsatility, was used to quantify pulsatile flow. The circuit consisted of an i‐cor diagonal pump, an adult XLung oxygenator, a 21 Fr Medtronic Biomedicus femoral arterial cannula, a 23/25 Fr Sorin RAP femoral venous cannula, and 3/8 in ID tubing for both arterial and venous lines. The circuit was primed with lactated Ringer's solution and then packed red blood cells (hematocrit 37%). Trials were conducted at 36°C with flow rates of 2‐5 L/min (1 L/min increments) under nonpulsatile and pulsatile mode with pulsatile amplitudes of 1000–5000 rpm (1000 rpm increments). The pseudopatient pressure was maintained at 40–100 mm Hg (20 mm Hg increments). Real‐time pressure and flow data were recorded for analysis using a custom‐made data acquisition system. There was no SHE generated by the pump under nonpulsatile mode. Under pulsatile mode, SHE levels increased with increasing pulsatile amplitude and pseudopatient pressure ( P < 0.01) but decreased with increasing flow rate. SHE levels were significantly higher at flow rates of 2–4 L/min. In addition, the XLung oxygenator had acceptable pressure drops (36.1–104.9 mm Hg) and percentages of total hemodynamic energy loss (19.6–43.9%) during all trials. The novel pulsatile ECMO system can create nonpulsatile and pulsatile flow in an adult ECMO model. However, pulsatility gradually weakened with increasing flow rates. Pulsatile amplitude settings were found to have a great impact on pulsatility.