Wang Shigang, Spencer Shannon B, Kunselman Allen R, Ündar Akif
Department of Pediatrics, Public Health and Sciences, Penn State Hershey Pediatric Cardiovascular Research Center.
Public Health and Sciences.
Artif Organs. 2017 Jan;41(1):55-65. doi: 10.1111/aor.12904.
The objective of this study is to evaluate electrocardiography (ECG)-synchronized pulsatile flow under varying heart rates and different atrial and ventricular arrhythmias in a simulated extracorporeal life support (ECLS) system. The ECLS circuit consisted of an i-cor diagonal pump and console, an iLA membrane ventilator, and an 18 Fr arterial cannula. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). An ECG simulator was used to trigger pulsatile flow and to generate selected cardiac rhythms. All trials were conducted at a flow rate of 2.5 L/min at room temperature for normal sinus rhythm at 45-180 bpm under non-pulsatile and pulsatile modes. Various atrial and ventricular arrhythmias were also tested. Real-time pressure and flow data were recorded using a custom-based data acquisition system. The energy equivalent pressure (EEP) generated by pulsatile flow was always higher than the mean pressure. No surplus hemodynamic energy (SHE) was recorded under non-pulsatile mode. Under pulsatile mode, SHE levels increased with increasing heart rates (45-120 bpm). SHE levels under a 1:2 assist ratio were higher than the 1:1 and 1:3 assist ratios with a heart rate of 180 bpm. A similar trend was recorded for total hemodynamic energy levels. There was no statistical difference between the two perfusion modes with regards to pressure drops across the ECLS circuit. The main resistance and energy loss came from the arterial cannula. The i-cor console successfully tracked electrocardiographic signals of 12 atrial and ventricular arrhythmias. Our results demonstrated that the i-cor pulsatile ECLS system can be synchronized with a normal heart rate or with various atrial/ventricular arrhythmias. Further in vivo studies are warranted to confirm our findings.
本研究的目的是在模拟体外生命支持（ECLS）系统中，评估不同心率以及不同房性和室性心律失常情况下的心电图（ECG）同步搏动血流。ECLS回路由一个i-cor对角泵及控制台、一台iLA膜式呼吸机和一根18 Fr动脉插管组成。回路用乳酸林格氏液和浓缩红细胞（血细胞比容35%）预充。使用一台ECG模拟器触发搏动血流并产生选定的心律。所有试验均在室温下以2.5 L/min的流速进行，针对45 - 180次/分钟的正常窦性心律，采用非搏动和搏动模式。还测试了各种房性和室性心律失常。使用基于定制的数据采集系统记录实时压力和血流数据。搏动血流产生的能量等效压力（EEP）总是高于平均压力。在非搏动模式下未记录到剩余血流动力学能量（SHE）。在搏动模式下，SHE水平随心率增加（45 - 120次/分钟）而升高。在心率为180次/分钟时，1:2辅助比下的SHE水平高于1:1和1:3辅助比。总血流动力学能量水平也记录到类似趋势。关于ECLS回路两端的压力降，两种灌注模式之间无统计学差异。主要阻力和能量损失来自动脉插管。i-cor控制台成功追踪了12种房性和室性心律失常的心电图信号。我们的结果表明，i-cor搏动性ECLS系统可与正常心率或各种房性/室性心律失常同步。有必要进行进一步的体内研究以证实我们的发现。
