Kanagarajan Dhayananth, Heinsar Silver, Gandini Lucia, Suen Jacky Y, Dau Van Thanh, Pauls Jo, Fraser John F
From the Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
ASAIO J. 2023 May 1;69(5):e167-e180. doi: 10.1097/MAT.0000000000001922. Epub 2023 Mar 27.
Refractory cardiogenic shock is increasingly being treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO), without definitive proof of improved clinical outcomes. Recently, pulsatile V-A ECMO has been developed to address some of the shortcomings of contemporary continuous-flow devices. To describe current pulsatile V-A ECMO studies, we conducted a systematic review of all preclinical studies in this area. We adhered to PRISMA and Cochrane guidelines for conducting systematic reviews. The literature search was performed using Science Direct, Web of Science, Scopus, and PubMed databases. All preclinical experimental studies investigating pulsatile V-A ECMO and published before July 26, 2022 were included. We extracted data relating to the 1) ECMO circuits, 2) pulsatile blood flow conditions, 3) key study outcomes, and 4) other relevant experimental conditions. Forty-five manuscripts of pulsatile V-A ECMO were included in this review detailing 26 in vitro , two in silico , and 17 in vivo experiments. Hemodynamic energy production was the most investigated outcome (69%). A total of 53% of studies used a diagonal pump to achieve pulsatile flow. Most literature on pulsatile V-A ECMO focuses on hemodynamic energy production, whereas its potential clinical effects such as favorable heart and brain function, end-organ microcirculation, and decreased inflammation remain inconclusive and limited.
难治性心源性休克越来越多地采用静脉-动脉体外膜肺氧合（V-A ECMO）进行治疗，但目前尚无确凿证据表明其能改善临床结局。最近，脉动式V-A ECMO已被开发出来，以解决当代连续流装置的一些缺点。为了描述当前脉动式V-A ECMO的研究情况，我们对该领域的所有临床前研究进行了系统综述。我们遵循PRISMA和Cochrane指南进行系统综述。文献检索使用了Science Direct、Web of Science、Scopus和PubMed数据库。纳入了所有在2022年7月26日前发表的、研究脉动式V-A ECMO的临床前实验研究。我们提取了与以下方面相关的数据：1）ECMO回路；2）脉动血流条件；3）关键研究结果；4）其他相关实验条件。本综述纳入了45篇关于脉动式V-A ECMO的手稿，详细介绍了26项体外实验、2项计算机模拟实验和17项体内实验。血流动力学能量产生是研究最多的结果（69%）。共有53%的研究使用对角泵来实现脉动血流。大多数关于脉动式V-A ECMO的文献都集中在血流动力学能量产生方面，而其潜在的临床效果，如对心脏和大脑功能的有益影响、终末器官微循环以及炎症减轻等，仍不明确且有限。
