Wang Shigang, Kunselman Allen R, Clark Joseph B, Ündar Akif
Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
Artif Organs. 2015 Jan;39(1):59-66. doi: 10.1111/aor.12430. Epub 2015 Jan 13.
The objective of this study is to investigate the impact of every component of extracorporeal life support (ECLS) circuit on hemodynamic energy transmission in terms of energy equivalent pressure (EEP), total hemodynamic energy (THE), and surplus hemodynamic energy (SHE) under nonpulsatile and pulsatile modes in a novel ECLS system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr femoral arterial cannula, a 23/25 Fr femoral venous cannula, and 3/8-in ID arterial and venous tubing. The circuit was primed with lactated Ringer's solution and human whole blood (hematocrit 33%). All trials were conducted under room temperature at the flow rates of 1-4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 beats per minute and differential speed values of 1000-4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom-based data acquisition system. EEP was significantly higher than mean arterial pressure in all experimental conditions under pulsatile flow (P < 0.01). THE was also increased under pulsatile flow compared with the nonpulsatile flow (P < 0.01). Under pulsatile flow conditions, SHE was significantly higher and increased differential rpm resulted in significantly higher SHE (P < 0.01). There was no SHE generated under nonpulsatile flow. Energy loss depending on the circuit components was almost similar in both perfusion modes at all different flow rates. The pressure drops across the oxygenator were 3.8-24.9 mm Hg, and the pressure drops across the arterial cannula were 19.3-172.6 mm Hg at the flow rates of 1-4 L/min. Depending on the pulsatility setting, i-cor ECLS system generates physiological quality pulsatile flow without increasing the mean circuit pressure. The iLA membrane ventilator is a low-resistance oxygenator, and allows more hemodynamic energy to be delivered to the patient under pulsatile mode. The 18 Fr femoral arterial cannula has acceptable pressure drops under nonpulsatile and pulsatile modes. Further in vivo studies are warranted to confirm these results.
本研究的目的是在一种新型体外膜肺氧合（ECLS）系统中，就能量等效压力（EEP）、总血流动力学能量（THE）和剩余血流动力学能量（SHE），研究ECLS回路的每个组件在非搏动性和搏动性模式下对血流动力学能量传递的影响。ECLS回路由i-cor对角泵及控制台（德国海尔布隆市Xenios AG公司）、一台iLA膜式呼吸机（Xenios AG公司）、一根18 Fr股动脉插管、一根23/25 Fr股静脉插管以及内径为3/8英寸的动静脉管道组成。回路用乳酸林格氏液和人全血（血细胞比容33%）预充。所有试验均在室温下以1 - 4 L/min的流速（每次增加1 L/min）进行。搏动流设置为搏动频率75次/分钟，差速值为1000 - 4000 rpm（每次增加1000 rpm）。使用基于定制的数据采集系统收集流量和压力数据。在搏动流下的所有实验条件下，EEP均显著高于平均动脉压（P < 0.01）。与非搏动流相比，搏动流下的THE也有所增加（P < 0.01）。在搏动流条件下，SHE显著更高，且差速rpm增加导致SHE显著更高（P < 0.01）。在非搏动流下未产生SHE。在所有不同流速下，两种灌注模式下取决于回路组件的能量损失几乎相似。在1 - 4 L/min的流速下，氧合器两端的压力降为3.8 - 24.9 mmHg，动脉插管两端的压力降为19.3 - 172.6 mmHg。根据搏动性设置，i-cor ECLS系统可产生生理质量的搏动流，而不会增加回路平均压力。iLA膜式呼吸机是一种低阻力氧合器，在搏动模式下可使更多血流动力学能量传递给患者。18 Fr股动脉插管在非搏动性和搏动性模式下的压力降均可接受。有必要进行进一步的体内研究以证实这些结果。
