Moroi Morgan, Force Madison, Wang Shigang, 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 Jul;42(7):E127-E140. doi: 10.1111/aor.13103. Epub 2018 Feb 23.
The objective was to assess the i-cor electrocardiogram-synchronized diagonal pump in terms of hemodynamic energy properties for off-label use in neonatal and pediatric extracorporeal life support (ECLS) circuits. The neonatal circuit consisted of an i-cor pump and console, a Medos Hilite 800 LT oxygenator, an 8Fr arterial cannula, a 10Fr venous cannula, 91 cm of 0.6-cm ID arterial tubing, and 91 cm of 0.6-cm ID venous tubing. The pediatric circuit was identical except it included a 12Fr arterial cannula, a 14Fr venous cannula, and a Medos Hilite 2400 LT oxygenator. Neonatal trials were conducted at 36°C with hematocrit 40% using varying flow rates (200-600 mL/min, 200 mL increments) and postarterial cannula pressures (40-100 mm Hg, 20 mm Hg increments) under nonpulsatile mode and pulsatile mode with various pulsatile amplitudes (1000-4000 rpm, 1000 rpm increments). Pediatric trials were conducted at different flow rates (800-1600 mL/min, 400 mL/min increments). Mean pressure and energy equivalent pressure increased with increasing postarterial cannula pressure, flow rate, and pulsatile amplitude. Physiologic-like pulsatility was achieved between pulsatile amplitudes of 2000-3000 rpm. Pressure drops were greatest across the arterial cannula. Pulsatile flow generated significantly higher total hemodynamic energy (THE) levels than nonpulsatile flow. THE levels at postarterial cannula site increased with increasing postarterial cannula pressure, pulsatile amplitude, and flow rate. No surplus hemodynamic energy (SHE) was generated under nonpulsatile mode. Under pulsatile mode, preoxygenator SHE increased with increasing postarterial cannula pressure and pulsatile amplitude, but decreased with increasing flow rate. The i-cor system can provide nonpulsatile and pulsatile flow for neonatal and pediatric ECLS. Pulsatile amplitudes of 2000-3000 rpm are recommended for use in neonatal and pediatric patients.
目的是评估i-cor心电图同步对角泵在新生儿和儿科体外生命支持（ECLS）回路中用于标签外使用时的血流动力学能量特性。新生儿回路由一个i-cor泵和控制台、一个Medos Hilite 800 LT氧合器、一个8Fr动脉插管、一个10Fr静脉插管、91厘米内径0.6厘米的动脉管路和91厘米内径0.6厘米的静脉管路组成。儿科回路与之相同，只是包括一个12Fr动脉插管、一个14Fr静脉插管和一个Medos Hilite 2400 LT氧合器。新生儿试验在36°C、血细胞比容40%的条件下进行，在非搏动模式和搏动模式下，使用不同的流速（200 - 600毫升/分钟，以200毫升递增）和动脉插管后压力（40 - 100毫米汞柱，以20毫米汞柱递增）以及各种搏动幅度（1000 - 4000转/分钟，以1000转/分钟递增）。儿科试验在不同流速（800 - 1600毫升/分钟，以400毫升/分钟递增）下进行。平均压力和能量等效压力随着动脉插管后压力、流速和搏动幅度的增加而增加。在2000 - 3000转/分钟的搏动幅度之间实现了类似生理的搏动性。动脉插管处的压力降最大。搏动流产生的总血流动力学能量（THE）水平显著高于非搏动流。动脉插管后部位的THE水平随着动脉插管后压力、搏动幅度和流速的增加而增加。在非搏动模式下未产生多余的血流动力学能量（SHE）。在搏动模式下，氧合器前的SHE随着动脉插管后压力和搏动幅度的增加而增加，但随着流速的增加而降低。i-cor系统可为新生儿和儿科ECLS提供非搏动流和搏动流。建议在新生儿和儿科患者中使用2000 - 3000转/分钟的搏动幅度。
