Comparison of Two Types of Neonatal Extracorporeal Life Support Systems With Pulsatile and Nonpulsatile Flow

Abstract

We compared the effects of two neonatal extracorporeal life support (ECLS) systems on circuit pressures and surplus hemodynamic energy levels in a simulated ECLS model. The clinical set-up included the Jostra HL-20 heart-lung machine, either the Medtronic ECMO (0800) or the MEDOS 800LT systems with company-provided circuit components, a 10 Fr arterial cannula, and a pseudo-patient. We tested the system in nonpulsatile and pulsatile flow modes at two flow rates using a 40/60 glycerin/water blood analog, for a total of 48 trials, with n = 6 for each set-up. The pressure drops over the Medtronic ECLS were significantly higher than those over the MEDOS system regardless of the flow rate or perfusion mode (144.8 +/- 0.2 mm Hg vs. 35.7 +/- 0.2 mm Hg, respectively, at 500 mL/min in nonpulsatile mode, P < 0.001). The preoxygenator mean arterial pressures were significantly increased and the precannula hemodynamic energy values were decreased with the Medtronic ECLS circuit. These results suggest that the MEDOS ECLS circuit better transmits hemodynamic energy to the patient, keeps mean circuit pressures lower, and has lower pressure drops than the Medtronic Circuit.

Evolution of Technology, Establishment of Program, and Clinical Outcomes in Pediatric Extracorporeal Membrane Oxygenation: The “SickKids” Experience

“…The silicone membrane is characterized by a long blood path and resultant high pressure gradient. Evaluation of the hollow‐fiber oxygenator in the laboratory demonstrated improved hemodynamics with decreased pressure drop across the hollow‐fiber membrane, indicating lower resistance to flow . The reduction in pressure should result in lower hemolysis and less inflammatory activation.…”

Speed Modulation of the Continuous-Flow Total Artificial Heart to Simulate a Physiologic Arterial Pressure Waveform

“…demonstrated that patients with continuous flow devices and patients with pulsatile flow devices have comparable renal function after LVAD implantation. Still, there is a longstanding debate over whether or not pulsatile flow provides better perfusion than nonpulsatile flow and what are or will be the long-term chronic effects of depulsation 7. We reported recently that reduced pulsatility resulting from a continuous-flow LVAD implantation induced periarteritis in the calf kidney 8.…”

Evolution of the Extracorporeal Life Support Circuitry

“…For the oxygenator, we compared two neonatal ECLS circuits with the new PMP HFMO or the conventional silicone oxygenator (7); we also evaluated three different HFMOs in terms of perfusion quality (8). For the pump, we not only compared the magnetically levitated centrifugal pump to the conventional roller pump in regard to the hemodynamic energy delivery as well as the air bubble handling (9), but we also evaluated the mechanical performance between two widely used centrifugal pumps (10).…”