In Vitro Evaluation of ECG‐Synchronized Pulsatile Flow Using the i‐cor Diagonal Pump in Neonatal and Pediatric ECLS Systems

Moroi, Morgan K.; Force, Madison; Wang, Shigang; Kunselman, Allen R.; Ündar, Akif

doi:10.1111/aor.13103

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…Our results once again showed that the i‐cor diagonal pump can generate non‐pulsatile and ECG‐synchronized pulsatile flow in our simulated pediatric and adult ECLS circuits . The i‐cor diagonal pump can generate pulsatile flow by changing the rotational speed.…”

Section: Discussionsupporting

confidence: 64%

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

et al. 2018

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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.

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Section: Discussionsupporting

confidence: 64%

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

et al. 2018

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“…We intentionally did not include the results from this particular diagonal pump in the materials and methods section of this manuscript, as it has not been approved by the FDA for clinical practice in the United States. The i‐Cor DP3 diagonal pump is also capable of providing pulsatile flow in addition to conventional non‐pulsatile flow . In addition, the i‐Cor pump is capable of providing ECG‐synchronized pulsatile flow by syncing the pulses of the pump with the patient’s native heartbeat.…”

Section: Discussionmentioning

confidence: 99%

“…The use of pulsatile flow during acute or chronic mechanical circulatory support for pediatric or adult patients is one of the major research areas at the Penn State Hershey Pediatric Cardiovascular Research Center. [16][17][18][19] The predecessor of the PediMag centrifugal pump was the Levitronix PediVAS system, which is capable of generating pulsatile flow and has been tested in an experimental setting at our research center. This pulsatile module was intended for experimental use only and has not been approved by the Food and Drug Administration (FDA) for use in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The i-Cor DP3 diagonal pump is also capable of providing pulsatile flow in addition to conventional non-pulsatile flow. [17][18][19][22][23][24] In addition, the i-Cor pump is capable of providing ECG-synchronized pulsatile flow by syncing the pulses of the pump with the patient's native heartbeat. We evaluated the i-Cor pump under non-pulsatile and pulsatile modes using the identical experimental settings of this particular investigation.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of centrifugal blood pumps in term of hemodynamic performance using simulated neonatal and pediatric ECMO circuits

et al. 2019

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The objective of this translational study was to evaluate the FDA‐approved PediMag, CentriMag, and RotaFlow centrifugal blood pumps in terms of hemodynamic performance using simulated neonatal and pediatric extracorporeal membrane oxygenation (ECMO) circuits with different sizes of arterial and venous cannulae. Cost of disposable pump heads was another important variable for this particular study. The experimental circuit was composed of one of the centrifugal pump heads, a polymethylpentene membrane oxygenator, neonatal and pediatric arterial/venous cannulae, and 1/4‐inch ID tubing. Circuits were primed with lactated Ringer’s solution and packed human red blood cells (hematocrit 35%). Trials were conducted at 36°C using the three pump heads and different cannulae (arterial/venous cannulae: 8 Fr/18 Fr, 10 Fr/20 Fr, and 12 Fr/22 Fr) at various flow rates (200–2400 mL/min, 200 mL/min increments) and rotational speeds. Pseudo patient pressure was 60 mm Hg. Real‐time pressure and flow data were recorded for analysis. The RotaFlow pump had a higher pressure head and flow range compared with the PediMag and CentriMag pumps at the same rotational speed and identical experimental settings (P < 0.001). The PediMag pump had lower flow output than others (P < 0.001). Small‐caliber arterial cannulae and higher flow rates predictably created higher circuit pressures and pressure drops. There was no significant difference in hemodynamic energy delivered to the pseudo patient with each of the three pumps. The arterial cannula had the highest pressure drop and hemodynamic energy loss in the circuit when compared to the oxygenator and arterial tubing. The RotaFlow centrifugal pump had a significantly better hemodynamic performance when compared to the PediMag and CentriMag blood pumps at identical experimental conditions in simulated neonatal and pediatric ECMO settings. In addition, the cost of the RotaFlow pump head ($400) is 20 to 30‐fold less than the other centrifugal pumps [CentriMag ($12 000) or PediMag ($8000)] that were evaluated in this translational study.

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“…Morgan Moroi et al of the Penn State Health Children's Hospital, Hershey, PA, USA, assessed the i‐cor electrocardiogram‐synchronized diagonal pump in terms of hemodynamic energy properties for off‐label use in neonatal and pediatric extracorporeal life support (ECLS) circuits. Pulsatile flow generated significantly higher total hemodynamic energy (THE) levels than nonpulsatile flow.…”

Section: Cardiac Support and Blood Pumpsmentioning

confidence: 99%

Artificial Organs 2018: A Year in Review

Malchesky¹

2019

Artificial Organs

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In this Editor's Review, articles published in 2018 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders “to foster communications in the field of artificial organs on an international level.” Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer‐reviewed special issues this year included contributions from the 13th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, and the 25th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Marvin Slepian. Additionally, many editorials highlighted the worldwide survival differences in hemodialysis and perspectives on mechanical circulatory support and stem cell therapies for cardiac support. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

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In Vitro Evaluation of ECG‐Synchronized Pulsatile Flow Using the i‐cor Diagonal Pump in Neonatal and Pediatric ECLS Systems

Cited by 10 publications

References 12 publications

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit

Evaluation of centrifugal blood pumps in term of hemodynamic performance using simulated neonatal and pediatric ECMO circuits

Artificial Organs 2018: A Year in Review

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