Wang Shigang, Force Madison, Kunselman Allen R, Brehm Christoph, Ündar Akif
Departments of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Public and Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Artif Organs. 2019 Jan;43(1):30-40. doi: 10.1111/aor.13345. Epub 2018 Nov 4.
The objective of this study is to evaluate the hemodynamic characteristics of two femoral arterial cannulae in terms of circuit pressure, pressure drop, and hemodynamic energy transmission under non-pulsatile and pulsatile modes in a simulated adult extracorporeal life support (ECLS) system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr or 16 Fr femoral arterial cannula (Xenios AG), and a 23/25 Fr Estech remote access perfusion (RAP) femoral venous cannula (San Ramon, CA, USA). The circuit was primed with lactated Ringer's solution and packed red blood cells to achieve a hematocrit of 35%. All trials were conducted at room temperature with flow rates of 1-4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 bpm and pulsatile amplitudes of 1000-4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom data acquisition system. Total hemodynamic energy (THE) is calculated by multiplying the ratio between the area under the hemodynamic power curve (∫flow × pressure dt) and the area under the pump flow curve (∫flow dt) by 1332. The pressure drop across the arterial cannula increased with increasing flow rate and decreasing cannula size. The pressure drops of 18 Fr and 16 Fr cannulae were 19.4-24.5 and 38.4-45.3 mm Hg at 1 L/min, 55.2-56.8 and 110.9-118.3 mm Hg at 2 L/min, 94.1-105.1 and 209.7-215.1 mm Hg at 3 L/min, and 169.2-172.6 and 376.4 mm Hg at 4 L/min, respectively. Pulsatile flow created more hemodynamic energy than non-pulsatile flow, especially at lower flow rates. The percentages of THE loss across 18 Fr and 16 Fr cannula were 16.0-18.7 and 27.5-30.8% at 1 L/min, 35.1-35.7 and 52.3-53.8% at 2 L/min, 48.3-50.3 and 67.3-68.4% at 3 L/min and 62.9-63.1 and 79.0% at 4 L/min. The hemodynamic performance of the arterial cannula should be evaluated before use in clinical practice. The pressure drops and percentages of THE loss across two cannulae tested using human blood were higher compared to the manufacturer's data tested using water. The cannula size should be chosen to match the expected flow rate. In addition, this novel i-cor ECLS system can provide non-pulsatile and ECG-synchronized pulsatile flow without significantly increasing the cannula pressure drop and hemodynamic energy loss.
本研究的目的是在模拟成人体外生命支持（ECLS）系统中，就非搏动性和搏动性模式下的回路压力、压力降和血流动力学能量传输，评估两种股动脉插管的血流动力学特性。ECLS回路由i-cor对角泵及控制台（德国海尔布隆市Xenios AG公司）、一台iLA膜式呼吸机（Xenios AG公司）、一根18 Fr或16 Fr股动脉插管（Xenios AG公司）和一根23/25 Fr Estech远程通路灌注（RAP）股静脉插管（美国加利福尼亚州圣拉蒙市）组成。回路用乳酸林格氏液和浓缩红细胞预充，使血细胞比容达到35%。所有试验均在室温下进行，流速为1 - 4 L/min（以1 L/min递增）。搏动流设置为搏动频率75次/分钟，搏动幅度1000 - 4000转/分钟（以1000转/分钟递增）。使用定制数据采集系统收集流量和压力数据。总血流动力学能量（THE）通过将血流动力学功率曲线下面积（∫流量×压力dt）与泵流量曲线下面积（∫流量dt）之比乘以1332来计算。动脉插管两端的压力降随流速增加和插管尺寸减小而增大。18 Fr和16 Fr插管在1 L/min时的压力降分别为19.4 - 至24.5 mmHg和38.4 - 45.3 mmHg，2 L/min时为55.2 - 56.8 mmHg和110.9 - 118.3 mmHg，3 L/min时为94.1 - 105.1 mmHg和209.7 - 215.1 mmHg，4 L/min时为169.2 - 172.6 mmHg和376.4 mmHg。搏动流比非搏动流产生更多的血流动力学能量，尤其是在较低流速时。18 Fr和16 Fr插管在1 L/min时THE损失百分比分别为16.0 - 18.7%和27.5 - 30.8%，2 L/min时为35.1 - 35.7%和52.3 - 53.8%，3 L/min时为48.3 - 50.3%和67.3 - 68.4%，4 L/min时为62.9 - 63.1%和79.0%。在临床实践中使用前，应评估动脉插管的血流动力学性能。与制造商用水测试的数据相比，用人血测试的两种插管的压力降和THE损失百分比更高。应选择合适尺寸的插管以匹配预期流速。此外，这种新型i-cor ECLS系统可提供非搏动性和心电图同步搏动流，而不会显著增加插管压力降和血流动力学能量损失。
