Force Madison, Moroi Morgan, Wang Shigang, Palanzo David A, Kunselman Allen R, Ündar Akif
Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Artif Organs. 2018 Apr;42(4):354-364. doi: 10.1111/aor.13073. Epub 2018 Jan 11.
The objective of this study was to compare three different hemoconcentrators (Hemocor HPH 400, Mini, and Junior) with two different neonatal ECMO circuits using a roller or a centrifugal pump at different pseudo-patient pressures and flow rates in terms of hemodynamic properties. This evidence-based research is necessary to optimize the ECMO circuitry for neonates. The circuits used a 300-mL soft-shell reservoir as a pseudo-patient approximating the blood volume of a 3 kg neonate, two blood pumps, and a Quadrox-iD Pediatric oxygenator with three different in-line hemoconcentrators (Hemocor HPH 400, Mini, and Junior). One circuit used a Maquet H20 roller pump and another circuit used a Maquet RotaFlow centrifugal pump. The circuit was primed with lactated Ringer's solution followed by heparinized packed red blood cells with a hematocrit of 40%. The pseudo-patient's pressure was manually maintained at 40, 60, or 80 mm Hg and the flow rate was maintained at 200, 400, or 600 mL/min with a circuit temperature of 36°C. Pressure and flow data was recorded using a custom-made data acquisition device. Mean pressures, diverted blood flow, pressure drops, and total hemodynamic energy (THE) were calculated for each experimental condition. The roller pump and centrifugal pump performed similarly for all hemodynamic properties with all experimental conditions. The Hemocor HPH Junior hemoconcentrator added the highest resistance to the circuit. The Hemocor HPH Junior provided the highest circuit pressures, lowest diverted blood flow, highest pressure drop across the circuit, and highest THE generated by the pump. The Hemocor HPH 400 added the least resistance to the circuit, providing the lowest circuit pressures, more diverted flow, lowest pressure drop, and the lowest THE generated by the pump. However, the THE delivered to the patient was the same for the three hemoconcentrators. While the three hemoconcentrators performed differently in terms of hemodynamic properties throughout the circuit, the THE transmitted to the patient was similar for all three hemoconcentrators due to the consistent pseudo-patient's pressure that was manually maintained for each trial. While the THE delivered to the patient indicates similar perfusion for these patients with any of the three hemoconcentrators, the differences in added resistance to the circuit may impact the decision of which hemoconcentrator is used. There was no clinically significant difference between the two circuits with the roller versus centrifugal pump in terms of hemodynamic properties in this study. Further in vivo research is warranted to confirm our findings.
本研究的目的是比较三种不同的血液浓缩器（Hemocor HPH 400、Mini和Junior）与两种不同的新生儿体外膜肺氧合（ECMO）回路，这两种回路分别使用滚压泵或离心泵，在不同的模拟患者压力和流速条件下，研究其血流动力学特性。这项基于证据的研究对于优化新生儿ECMO回路是必要的。这些回路使用一个300毫升的软壳储液器作为模拟患者，近似3千克新生儿的血容量，两个血泵，以及一个Quadrox-iD儿科氧合器和三种不同的在线血液浓缩器（Hemocor HPH 400、Mini和Junior）。一个回路使用迈柯唯H20滚压泵，另一个回路使用迈柯唯RotaFlow离心泵。回路先用乳酸林格氏液预充，然后用血细胞比容为40%的肝素化压积红细胞预充。模拟患者的压力手动维持在40、60或80毫米汞柱，流速维持在200、400或600毫升/分钟，回路温度为36°C。压力和流量数据使用定制的数据采集设备记录。计算每种实验条件下的平均压力、分流血流量、压力降和总血流动力学能量（THE）。在所有实验条件下，滚压泵和离心泵在所有血流动力学特性方面表现相似。Hemocor HPH Junior血液浓缩器给回路增加的阻力最大。Hemocor HPH Junior产生的回路压力最高，分流血流量最低，回路两端的压力降最高，泵产生的THE最高。Hemocor HPH 400给回路增加的阻力最小，产生的回路压力最低，分流流量更多，压力降最低，泵产生的THE最低。然而，三种血液浓缩器输送给患者的THE是相同的。虽然三种血液浓缩器在整个回路的血流动力学特性方面表现不同，但由于每次试验中手动维持的模拟患者压力一致，三种血液浓缩器传输给患者的THE相似。虽然输送给患者的THE表明使用这三种血液浓缩器中的任何一种对这些患者的灌注相似，但回路中增加的阻力差异可能会影响选择使用哪种血液浓缩器 的决定。在本研究中，使用滚压泵和离心泵的两种回路在血流动力学特性方面没有临床显著差异。有必要进行进一步的体内研究来证实我们的发现。
