Extracorporeal life support (ECLS) offers lifesaving mechanical circulatory support for patients afflicted with respiratory and/or cardiac failure. Neonatal respiratory patients have higher survival rates compared to pediatric patients, while, for cardiac cases, pediatric patients are more likely to survive. The indications for ECLS have been expanded due to the improved technology and favorable outcomes. However, the rate of mortality and morbidity for ECLS patients remains significant. Mechanical complications still comprise a large percentage of ECLS complications, leaving definite room for improvement in ECLS circuit technology in the future. As a pre-clinical evaluating tool, translational research will provide more useful information for the selection of ECLS devices, encourage further development of ECLS technology, and, ultimately, benefit the patients.

Emerging technologies and practices for pediatric and neonatal extracorporeal life support (ECLS) are promising. This experiment sought to compare the Medtronic 0800 silicon rubber membrane oxygenator to the Quadrox-iD Pediatric oxygenator in the conventional roller pump circuit, as well as comparing the conventional circuit to an alternative circuit. Three circuits were set up in the experiment. Two conventional roller pump circuits were used to compare the two oxygenators and an alternative circuit consisting of the Quadrox-iD Pediatric oxygenator and Maquet Rotaflow centrifugal pump system was used to identify differences between circuits. All three circuits were primed with Lactated Ringers' solution and human blood, with an hematocrit of 40%. Testing occurred at flow rates of 250, 500, and 750 ml/ min at 37°C for mean arterial line pressures of 60, 80, and 100 mmHg. The results of the experiment showed lower pressure drops and greater retention of total hemodynamic energy (THE) across the Quadrox-iD Pediatric oxygenator compared to the Medtronic 0800 oxygenator. Furthermore, the centrifugal pump used in the alternative circuit showed no back flow at flow rates as low as 250 ml/min while, on the other hand, rpm levels were kept below 2200 for flow rates as high as 750 ml/min. Findings support the usage of the Quadrox-iD Pediatric oxygenator in a circuit utilizing the Maquet Rotaflow centrifugal pump system due to lower pressure drops and greater percentage of THE retained across the circuit. Additional advantages of the alternative circuit include rapid set-up time, easy transport, lower priming volumes, and no gravity-dependent venous drainage system so that it can be situated in close proximity to and at the level of the patient.

This study compared the quality of perfusion delivered by two oxygenators--the hollow-fiber membrane Capiox Baby RX05 and silicone membrane Medtronic 0800--using hemodynamic energy indicators. The oxygenators were tested across varying flow rates and perfusion modes in a neonatal extracorporeal life support (ECLS) model. The experimental ECLS circuit included a Jostra HL-20 heart/lung machine with Jostra Roller pump, oxygenators with associated tubing and components, and a neonatal pseudo-patient. We used a 40/60 glycerin/water solution in the circuit as a blood analog. Testing occurred at flow rates of 250, 500, and 750 mL/min at 37°C under both pulsatile and nonpulsatile flow conditions. Hemodynamic data points consisted of recording 20-s intervals of data, and a total of 96 experimental repetitions were conducted. The pressure drop across the Capiox Baby RX05 oxygenator was significantly lower than the pressure drop across the Medtronic 0800 at all flow rates and perfusion modes. Furthermore, the Medtronic 0800 oxygenator showed significantly lower post-oxygenator energy equivalent pressures, total hemodynamic energy values, and surplus hemodynamic energy retention values compared to those of the Capiox Baby RX05. These results indicate the Medtronic 0800 oxygenator significantly dampens the hemodynamic energy compared to the Capiox Baby RX05. Consequently, clinical use of the Medtronic 0800 in a pulsatile ECLS setting is likely to mitigate the benefits provided by pulsatile flow. In contrast, the Capiox Baby RX05 better transmits hemodynamic energy to the patient with much lower pressure drop.