Wang Shigang, Krawiec Conrad, Patel Sunil, Kunselman Allen R, Song Jianxun, Lei Fengyang, Baer Larry D, Ündar Akif
Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Pediatric Critical Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Artif Organs. 2015 Sep;39(9):774-81. doi: 10.1111/aor.12466. Epub 2015 May 1.
The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12 h at a flow rate of 500 mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean ± standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6 ± 253.1 mg/L, DP3-NP group: 343.7 ± 163.2 mg/L, and DP3-P group: 407.6 ± 156.6 mg/L, P = 0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P > 0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P < 0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.
本研究的目的是在模拟新生儿体外生命支持（ECLS）系统中，比较传统滚压泵（HL20-NP）与另一种非搏动模式（DP3-NP）和搏动模式（DP3-P）的斜流泵的全身炎症反应和溶血特性。实验性新生儿ECLS回路由传统的Jostra HL20滚压泵或另一种Medos DP3斜流泵，以及带有扩散膜的Medos Hilite 800 LT中空纤维氧合器组成。18个无菌回路用新鲜捐献的全血预充，并分为三组：非搏动流的传统HL20（HL20-NP）、非搏动流的DP3（DP3-NP）和搏动流的DP3（DP3-P）。所有试验在36°C下以500 mL/min的流速进行12小时。同时记录血流和压力波形。采集血样以测量血浆游离血红蛋白（PFH）、人肿瘤坏死因子-α、白细胞介素-6（IL-6）和IL-8，以及常规血气、乳酸脱氢酶和乳酸水平。在12小时的ECLS运行后，HL20-NP组的PFH水平最高（均值±均值标准误差），但各组之间的差异未达到统计学显著性（HL20-NP组：907.6±253.1 mg/L，DP3-NP组：343.7±163.2 mg/L，DP3-P组：407.6±156.6 mg/L，P = 0.06）。尽管三组中促炎细胞因子水平有相似趋势但无统计学差异，但HL-20-NP组的水平比其他组高得多（P>0.05）。搏动流在氧合器前和夹闭前部位产生更高的总血流动力学能量和剩余血流动力学能量水平（P<0.01）。我们的研究表明，在模拟新生儿ECLS系统中，与传统滚压泵ECLS回路相比，另一种斜流泵ECLS回路似乎具有更少的全身炎症反应和溶血。与传统的非搏动滚压泵组相比，搏动流在不增加溶血几率的情况下为模拟患者输送了更多的血流动力学能量。
