Ündar Akif, Wang Shigang, Moroi Morgan, Kunselman Allen R, Brehm Christoph E
Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Department of Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Artif Organs. 2018 Aug;42(8):776-785. doi: 10.1111/aor.13126. Epub 2018 Mar 25.
The objective of this study was to evaluate three commercially available ECLS systems with rotary pumps in terms of circuit pressure, pressure drop, perfusion modes, and hemodynamic energy transmission in a simulated adult cardiogenic shock model. One circuit consisted of a Cardiohelp system, which included a Cardiohelp console and HLS Module Advanced 7.0 tubing set with integrated centrifugal pump and oxygenator. The alternative circuit was composed of a Quadrox-D Adult oxygenator connected in series with either an i-cor diagonal pump and console or a Rotaflow centrifugal pump and console. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%). The trials were conducted at flow rates of 1-5 L/min with pseudo patient pressures of 60 mm Hg and 80 mm Hg. Pulsatile flow was tested when using the i-cor system. Mean pre-oxygenator pressure and pressure drop across ECLS circuit (including oxygenator and arterial tubing) were lower when using the Cardiohelp system as compared to the Rotaflow and i-cor systems (P < 0.01). The i-cor system was able to deliver more hemodynamic energy to the pseudo patient because of its ability to produce pulsatile flow (P < 0.01). The Cardiohelp HLS Module Advanced 7.0 integrated oxygenator had a lower resistance than the Quadrox-D oxygenator. Although the compact Cardiohelp system had a better hemodynamic performance when compared to Rotaflow and i-cor systems, the pulsatile flow of the i-cor system delivered more hemodynamic energy to the pseudo patient. This may render more physiological benefits in high-risk patients on ECLS.
本研究的目的是在模拟成人心源性休克模型中，从回路压力、压力降、灌注模式和血流动力学能量传输方面评估三种市售的带旋转泵的体外膜肺氧合（ECLS）系统。一个回路由Cardiohelp系统组成，该系统包括一个Cardiohelp控制台和带有集成离心泵和氧合器的HLS模块高级7.0管路套件。另一个回路由Quadrox-D成人氧合器与i-cor对角泵及控制台或Rotaflow离心泵及控制台串联组成。回路用乳酸林格氏溶液和浓缩红细胞（血细胞比容40%）预充。试验在流速为1 - 5 L/min、模拟患者压力为60 mmHg和80 mmHg的条件下进行。使用i-cor系统时测试了搏动流。与Rotaflow和i-cor系统相比，使用Cardiohelp系统时，氧合器前平均压力和整个ECLS回路（包括氧合器和动脉管路）的压力降更低（P < 0.01）。由于i-cor系统能够产生搏动流，它能够向模拟患者输送更多的血流动力学能量（P < 0.01）。Cardiohelp HLS模块高级7.0集成氧合器的阻力低于Quadrox-D氧合器。尽管紧凑型Cardiohelp系统与Rotaflow和i-cor系统相比具有更好的血流动力学性能，但i-cor系统的搏动流向模拟患者输送了更多的血流动力学能量。这可能会给接受ECLS的高危患者带来更多生理益处。
