Comparison of hollow-fiber membrane oxygenators with different perfusion                 modes during normothermic and hypothermic CPB in a simulated neonatal model

Ündar, Akif; Ji, Bingyang; Lukic, Branka; Zapanta, Conrad M.; Kunselman, Allen R.; Reibson, John; Khalapyan, Tigran; Baer, Larry D.; Weiss, Jason; Rosenberg, Gerson; Myers, John L.

doi:10.1177/0267659106073996

Cited by 12 publications

(12 citation statements)

References 15 publications

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“…They must be carefully selected for studies of pulsatile flow and tested for their suitability with pulsatile flow. It has been proved that different brands of hollow‐fiber membrane oxygenators resulted in different energy decrements (10,13). The geometry of the aortic cannula also plays an important role in producing adequate pulsatile flow (14).…”

Section: Discussionmentioning

confidence: 99%

Pulsatile Flow Improves Cerebral Blood Flow in Pediatric Cardiopulmonary Bypass

Wang¹,

Shu-ying²,

Zhang³

et al. 2010

Artificial Organs

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The objective of this study was to evaluate the effect of pulsatile flow on cerebral blood flow (CBF) in infants with the use of a mild hypothermic cardiopulmonary bypass (CPB). Thirty infants scheduled for open heart surgery were randomized to the pulsatile group (Group P, n = 15) and nonpulsatile group (Group NP, n = 15). In Group P, pulsatile perfusion was applied during the aortic cross-clamping period, whereas nonpulsatile perfusion was used in Group NP. The systolic peak velocity (Vs), the end of diastolic velocity (Vd), the mean velocity (Vm), and the pulsatility index (PI) and the resistance index (RI) of the middle cerebral artery were measured by a transcranial Doppler (TCD) ultrasound after anesthesia (T1; baseline), at the beginning of CPB (T2), 10 min after aortic cross-clamping (T3), 3 min after declamping (T4), at the cessation of CPB (T5), and at the end of the operation (T6). During T3 and T4, the Vs in Group P was significantly higher than in Group NP. However, there were no statistically significant differences between Vd and Vm. The PI and RI in Group P were also higher than those in Group NP (both P < 0.05). During T5, Vd and Vm were higher in Group P (P < 0.05), whereas there was no difference in Vs. Additionally, PI and RI in Group P were significantly lower than those in Group NP (P < 0.05). However, there was no difference during T6. Pulsatile perfusion may increase CBF and decrease cerebral vascular resistance in the early period after mild hypothermic CPB.

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Section: Discussionmentioning

confidence: 99%

Pulsatile Flow Improves Cerebral Blood Flow in Pediatric Cardiopulmonary Bypass

Wang¹,

Shu-ying²,

Zhang³

et al. 2010

Artificial Organs

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“…12,19,31 In addition, the structure and designs of hollow fiber membrane oxygenators have been found to have various impacts on pressure drops and quality of pulsatility as determined by EEP and SHE. 32 Also, a large part of hemodynamic energy has been reported to be absorbed by the arterial filter and arterial tubing. 33 Aortic cannula length and geometry are also plausible causes of differences in SHE delivery.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Hemodynamic Energy at Different Vessels in an Adult Swine Model

Son

Ahn

Lee³

et al. 2010

ASAIO Journal

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Extra hemodynamic energy is one of the major benefits of pulsatile flow, improving blood flow to vital organs. But most (80%) of the hemodynamic energy generated from pulsatile flow is damped by the extracorporeal circuit. Most models devised to minimize hemodynamic energy loss have been in vitro pediatric models. The purpose of this study was to measure hemodynamic energy in different vessels of different organs with an in vivo adult swine model. An extracorporeal circuit was constructed for seven Yorkshire swine using a pulsatile pump (Twin-Pulse Life Support). The mean arterial pressure (MAP), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) at the renal artery, carotid artery, aortic cannula site, and postoxygenator site were measured simultaneously before starting the pump and at the pump rates of 25, 35, and 45 bpm. The MAP of the renal or carotid artery was 40.0%-51.2% of the postoxygenator site. The EEP and SHE of both arteries were 11.6%-13.0% and 5.5%-7.4% of the postoxygenator site, respectively. The MAP and EEP of both arteries after starting the pump were lower than at baseline. The SHE of the renal artery after starting the pump was significantly higher than at baseline. The SHE of the carotid artery increased substantially after starting the pump although not statistically significantly. There was a significant hemodynamic energy loss in both arterial sites compared with the postoxygenator site. Also, a difference in hemodynamic energy loss was observed in vessel-to-vessel or vessel-to-circuit site comparison. This difference creates a bias in studying pulsatility and its effects. Therefore, the measurement method of hemodynamic energy must be standardized and the measurement site clarified to yield accurate study results.

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“…15,17 Paradoxically, higher temperatures are associated with an increase in plasma viscosity due to alterations in the structure of the plasma proteins. 18 Haemoglobin has been traditionally considered an important determinant of blood viscosity.…”

Section: Discussionmentioning

confidence: 99%

Effect of flow rate and temperature on transmembrane blood pressure drop in an extracorporeal artificial lung

et al. 2014

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During its passage through the extracorporeal system, blood is exposed to pressure variations from -120 to 450 mmHg. At high blood flows (above 2 L/min), the drop in transmembrane pressure becomes unpredictable and highly variable. Over the entire range of blood flows investigated (0-5500 mL/min), the drop in transmembrane pressure was positively associated with blood flow and negatively associated with body temperature.

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Comparison of hollow-fiber membrane oxygenators with different perfusion modes during normothermic and hypothermic CPB in a simulated neonatal model

Abstract: The Capiox oxygenator had a significantly lower pressure drop in both pulsatile and non-pulsatile perfusion modes. For each oxygenator, the SHE levels were significantly higher in the pulsatile mode.

Cited by 12 publications

References 15 publications

Pulsatile Flow Improves Cerebral Blood Flow in Pediatric Cardiopulmonary Bypass

Pulsatile Flow Improves Cerebral Blood Flow in Pediatric Cardiopulmonary Bypass

Measurement of Hemodynamic Energy at Different Vessels in an Adult Swine Model

Effect of flow rate and temperature on transmembrane blood pressure drop in an extracorporeal artificial lung

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