Wang Shigang, Palanzo David, Kunselman Allen R, Ündar Akif
Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA, USA.
Perfusion Department, Penn State Heart and Vascular Institute, Penn State Hershey Children's Hospital, Hershey, PA, USA.
Artif Organs. 2016 Jan;40(1):56-64. doi: 10.1111/aor.12579. Epub 2015 Nov 2.
The objective of this study was to evaluate five small-bore arterial cannulae (6Fr and 8Fr) in terms of pressure drop and hemodynamic performance in simulated neonatal cardiopulmonary bypass (CPB) circuits. The experimental circuits consisted of a Jostra HL-20 roller pump, a Terumo Capiox Baby FX05 oxygenator with integrated arterial filter, an arterial and a venous tubing (1/4, 3/16, or 1/8 in × 150 cm), and an arterial cannula (Medtronic Bio-Medicus 6Fr and 8Fr, Maquet 6Fr and 8Fr, or RMI Edwards 8Fr). The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates (6Fr: 200-400 mL/min; 8Fr: 200-600 mL/min) and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Higher circuit pressure, circuit pressure drop, and hemodynamic energy loss across the circuit were recorded when using small-bore arterial cannula and small inner diameter arterial tubing in a neonatal CPB circuit. The maximum preoxygenator pressures reached 449.7 ± 1.0 mm Hg (Maquet 6Fr at 400 mL/min), and 395.7 ± 0.4 mm Hg (DLP 8Fr at 600 mL/min) when using 1/8 in ID arterial tubing at 28°C. Hypothermia further increased circuit pressure drop and hemodynamic energy loss. Compared with the others, the RMI 8Fr arterial cannula had significantly lower pressure drop and energy loss. Maquet 6Fr arterial cannula had a greater pressure drop than the DLP 6Fr. A small-bore arterial cannula and arterial tubing created high circuit pressure drop and hemodynamic energy loss. Appropriate arterial cannula and arterial tubing should be considered to match the expected flow rate. Larger cannula and tubing are recommended for neonatal CPB. Low-resistance neonatal arterial cannulae need to be developed.
本研究的目的是在模拟新生儿体外循环（CPB）回路中，从压力降和血流动力学性能方面评估五种小口径动脉插管（6Fr和8Fr）。实验回路由一台Jostra HL-20滚压泵、一台带集成动脉过滤器的Terumo Capiox Baby FX05氧合器、一根动脉和一根静脉管道（1/4英寸、3/16英寸或1/8英寸×150厘米）以及一根动脉插管（美敦力Bio-Medicus 6Fr和8Fr、迈柯唯6Fr和8Fr或RMI爱德华兹8Fr）组成。回路用乳酸林格氏溶液和肝素化的人浓缩红细胞（血细胞比容30%）预充。试验在不同流速（6Fr：200 - 400毫升/分钟；8Fr：200 - 600毫升/分钟）和温度（35和28°C）下进行。使用基于定制的数据采集系统收集流量和压力数据。在新生儿CPB回路中使用小口径动脉插管和小内径动脉管道时，记录到回路压力、回路压力降以及回路中的血流动力学能量损失更高。在28°C使用1/8英寸内径的动脉管道时，预氧合器前的最大压力分别达到449.7±1.0毫米汞柱（迈柯唯6Fr，流速400毫升/分钟）和395.7±0.4毫米汞柱（DLP 8Fr，流速600毫升/分钟）。低温进一步增加了回路压力降和血流动力学能量损失。与其他插管相比，RMI 8Fr动脉插管的压力降和能量损失显著更低。迈柯唯6Fr动脉插管的压力降比DLP 6Fr更大。小口径动脉插管和动脉管道会产生较高的回路压力降和血流动力学能量损失。应考虑使用合适的动脉插管和动脉管道以匹配预期流速。对于新生儿CPB，建议使用更大口径的插管和管道。需要开发低阻力的新生儿动脉插管。
