Glass Kristen, Trivedi Payal, Wang Shigang, Woitas Karl, Kunselman Allen R, Ündar Akif
Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
Neonatal Intensive Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
Artif Organs. 2017 Apr;41(4):392-400. doi: 10.1111/aor.12908.
Neurologic complications during neonatal extracorporeal life support (ECLS) are associated with significant morbidity and mortality. Gaseous microemboli (GME) in the ECLS circuit may be a possible cause. Advances in neonatal circuitry may improve hemodynamic performance and GME handling leading to reduction in patient complications. This study compared hemodynamic performance and GME handling using two centrifugal pumps (Maquet RotaFlow and Medos Deltastream DP3) and polymethylpentene oxygenators (Maquet Quadrox-iD and Medos Hilite 800LT) in a neonatal ECLS circuit model. The experimental circuit was primed with Lactated Ringer's solution and packed human red blood cells (hematocrit 40%) and arranged in parallel with the RotaFlow and DP3 pump, Quadrox-iD and Hilite oxygenator, and Better-Bladder. Hemodynamic trials evaluating pressure drops and total hemodynamic energy (THE) were conducted at 300 and 500 mL/min at 36°C. GME handling was measured after 0.5 mL of air was injected into the venous line using the Emboli Detection and Classification Quantifier System with unique pump, oxygenator, and Better-Bladder combinations. The RotaFlow pump and Quadrox oxygenator arrangement had lower pressure drops and THE loss at both flow rates compared to the DP3 pump and Hilite oxygenator (P < 0.01). Total GME volume and counts decreased with Better-Bladder at both flow rates with all combinations (P < 0.01). Hemodynamic performance and energy loss were similar in all of the circuit combinations. The Better-Bladder significantly decreased GME. All four combinations of pumps and oxygenators also performed similarly in terms of GME handling.
新生儿体外生命支持（ECLS）期间的神经系统并发症与显著的发病率和死亡率相关。ECLS回路中的气态微栓子（GME）可能是一个潜在原因。新生儿回路的进展可能会改善血流动力学性能和GME处理，从而减少患者并发症。本研究在新生儿ECLS回路模型中比较了使用两种离心泵（迈柯唯RotaFlow和美多斯Deltastream DP3）和聚甲基戊烯氧合器（迈柯唯Quadrox-iD和美多斯Hilite 800LT）时的血流动力学性能和GME处理情况。实验回路用乳酸林格氏溶液和浓缩人红细胞（血细胞比容40%）预充，并与RotaFlow泵、DP3泵、Quadrox-iD氧合器、Hilite氧合器和Better-Bladder并联设置。在36°C下，以300和500 mL/min的流速进行评估压降和总血流动力学能量（THE）的血流动力学试验。使用具有独特泵、氧合器和Better-Bladder组合的栓子检测和分类定量系统，在向静脉管路注入0.5 mL空气后测量GME处理情况。与DP3泵和Hilite氧合器相比，RotaFlow泵和Quadrox氧合器组合在两种流速下的压降和THE损失均较低（P < 0.01）。在所有组合中，使用Better-Bladder时，两种流速下的总GME体积和数量均减少（P < 0.01）。所有回路组合的血流动力学性能和能量损失相似。Better-Bladder显著减少了GME。在GME处理方面，泵和氧合器的所有四种组合表现也相似。
