Pediatric Cardiovascular Research Center, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Department of Pediatrics, Penn State Hershey College of Medicine, Hershey, PA, USA.
Artif Organs. 2014 Jan;38(1):E1-9. doi: 10.1111/aor.12240. Epub 2013 Dec 23.
One approach with the potential to improve morbidity and mortality rates following extracorporeal life support (ECLS) is the use of pulsatile perfusion. Currently, no ECLS pumps used in the United States can produce pulsatile flow. The objective of this experiment is to evaluate a novel diagonal pump used in Europe to determine whether it provides physiological pulsatility in a neonatal model. The ECLS circuit consisted of a Medos Deltastream DP3 diagonal pump, a Hilite 800LT polymethylpentene diffusion membrane oxygenator, and arterial/venous tubing. A 300-mL pseudopatient was connected to the circuit using an 8Fr arterial cannula and a 10Fr venous cannula. A clamp maintained constant pressure entering the pseudopatient. Trials (64 total) were conducted in nonpulsatile and pulsatile modes at flow rates of 200 mL/min to 800 mL/min. Flow and pressure data were collected using a custom-based data acquisition system. The Deltastream DP3 pump was capable of producing an adequate quality of pulsatility. Pulsatile flow produced increased mean arterial pressure, energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) at all flow rates compared to nonpulsatile flow. Pressure drop across the cannula accounted for the majority of pressure loss in the circuit. The greatest loss of SHE and total hemodynamic energy occurred across the arterial cannula due to its small diameter. The Deltastream DP3 pump produced physiological pulsatile flow without backflow while providing EEP and SHE to our neonatal pseudopatient. Further experiments are necessary to determine the impact of this pulsatile pump in an in vivo model prior to clinical use.
一种有潜力提高体外生命支持（ECLS）后发病率和死亡率的方法是使用脉动灌注。目前，美国没有任何一种 ECLS 泵能够产生脉动流。本实验的目的是评估一种在欧洲使用的新型对角泵，以确定它是否能在新生儿模型中提供生理脉动。ECLS 回路由 Medos Deltastream DP3 对角泵、Hilite 800LT 聚甲基戊烯扩散膜氧合器和动脉/静脉管组成。使用 8Fr 动脉插管和 10Fr 静脉插管将 300 毫升模拟患者连接到回路。夹管保持进入模拟患者的恒压。在 200 至 800 毫升/分钟的流速下，以非脉动和脉动模式进行了 64 次试验。使用基于定制的数据采集系统收集流量和压力数据。Deltastream DP3 泵能够产生足够质量的脉动。与非脉动流量相比，脉动流量在所有流速下都能增加平均动脉压、能量等效压力（EEP）和剩余血流动力学能量（SHE）。导管内的压降占回路内大部分压力损失。由于动脉插管的直径较小，因此 SHE 和总血流动力学能量的损失最大。Deltastream DP3 泵在提供 EEP 和 SHE 给我们的新生儿模拟患者的同时，能够产生无反流的生理脉动流。在临床应用之前，需要进一步的实验来确定这种脉动泵在体内模型中的影响。
