Agati Salvatore, Ciccarello Giuseppe, Ocello Salvatore, Salvo Dario, Marcelletti Carlo, Undar Akif, Mignosa Carmelo
Pediatric Cardiac Surgery Unit, San Vincenzo Hospital, Taormina, Italy.
ASAIO J. 2006 Sep-Oct;52(5):501-4. doi: 10.1097/01.mat.0000235272.00801.16.
The purpose of this investigation was to present the first European clinical experience with the new MEDOS DELTASTREAM DP1 used in pulsatile extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) options in the pediatric population. Between January 2002 and April 2006, 11 patients required ECMO and 5 patients received a left VAD (LVAD) in the San Vincenzo Hospital. Indications were postcardiotomy heart failure in 15 patients and fulminant myocarditis in one patient. ECMO was established in all patients by cannulation of the right atrium and ascending aorta. LVAD was instituted by cannulation of the left atrium and ascending aorta. The DP1, an extracorporeal rotary blood pump, was used as an ECMO and an LVAD device. The pump features a diagonal-flow impeller and can be used for both continuous and pulsatile modes of perfusion. Priming volume of the pump was approximately 30 ml, with a flow rate of up to 8 l/min. Ten patients were discharged from ECMO and four from VAD. In the ECMO group, one patient died of peritonitis while on ECMO and two patients died on days 3 and 4 after weaning because of persistent pulmonary hypertension and major neurologic complications. In the VAD group, one patient died of low output syndrome 9 days after weaning. A 12-year-old patient was successfully given transplantation on day 8 of ECMO support and discharged on day 30 after heart transplant. All other patients were discharged. Three pumps were changed for pump failure and one pump was electively replaced because of improper anticoagulation management. No other thromboembolic adverse events occurred. Our results suggest that the MEDOS DELTASTREAM DP1 pulsatile pump system can be used as an ECMO or a VAD support. The opportunity to utilize pulsatile flow in postcardiotomy cardiogenic shock significantly improved the outcomes by producing more physiologic hemodynamics and superior end organ function. Easy implantation and simple management of this device represents the major advantage.
本研究的目的是介绍是介绍新型MEDOS DELTASTREAM DP1在儿科患者搏动性体外膜肺氧合（ECMO）或心室辅助装置（VAD）中的首次欧洲临床经验。2002年1月至2006年4月期间，圣维森佐医院有11例患者需要ECMO，5例患者接受了左心室辅助装置（LVAD）。适应症包括15例心脏术后心力衰竭患者和1例暴发性心肌炎患者。所有患者均通过右心房和升主动脉插管建立ECMO。LVAD通过左心房和升主动脉插管植入。DP1是一种体外旋转血泵，用作ECMO和LVAD装置。该泵具有斜流叶轮，可用于连续和搏动灌注模式。泵的预充量约为30 ml，流速高达8 l/min。10例患者脱离ECMO，4例患者脱离VAD。在ECMO组中，1例患者在接受ECMO治疗时死于腹膜炎，2例患者在撤机后第3天和第4天因持续性肺动脉高压和严重神经并发症死亡。在VAD组中，1例患者在撤机后9天死于低输出量综合征。一名12岁患者在ECMO支持的第8天成功接受移植，并在心脏移植后第30天出院。所有其他患者均已出院。3台泵因泵故障更换，1台泵因抗凝管理不当而被选择性更换。未发生其他血栓栓塞不良事件。我们的结果表明，MEDOS DELTASTREAM DP1搏动泵系统可作为ECMO或VAD支持。在心脏术后心源性休克中利用搏动血流的机会通过产生更生理性的血流动力学和更好的终末器官功能显著改善了预后。该装置易于植入和管理是其主要优点。
