In Vitro Hemodynamic Evaluation of ECG‐Synchronized Pulsatile Flow Using i‐Cor Pump as Short‐Term Cardiac Assist Device for Neonatal and Pediatric Population

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

doi:10.1111/aor.13136

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…For example, the ECG-synchronized i-cor system has been verified in vitro for use in neonatal and pediatric ECLS, with pulsatile amplitudes of 2000-3000rpm achieving physiologic pulsatility (18,19). The i-cor system has also been shown to provide physiologic-like pulsatility in vitro when used as a short term cardiac assist device for neonatal and pediatric patients (19). The setting of pulsatile amplitudes of two pumps are designed by manufacturers.…”

Section: Discussionmentioning

confidence: 99%

“…After many technological advances, the current third‐generation Medos DeltaStream DP3 diagonal pump and modified i‐cor diagonal pump are able to provide further optimized pulsatile flow for ECLS and CPB procedures. For example, the ECG‐synchronized i‐cor system has been verified in vitro for use in neonatal and pediatric ECLS, with pulsatile amplitudes of 2000–3000rpm achieving physiologic pulsatility . The i‐cor system has also been shown to provide physiologic‐like pulsatility in vitro when used as a short term cardiac assist device for neonatal and pediatric patients .…”

Section: Discussionmentioning

confidence: 99%

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Effects of Pulsatile Control Algorithms for Diagonal Pump on Hemodynamic Performance and Hemolysis

et al. 2018

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The objective of this study is to compare hemodynamic performances under different pulsatile control algorithms between Medos DeltaStream DP3 and i‐cor diagonal pumps in simulated pediatric and adult ECLS systems. An additional pilot study was designed to test hemolysis using two pumps during 12h‐ECLS. The experimental circuit consisted of parallel combined pediatric and adult ECLS circuits using an i‐cor pump head and either an i‐cor console or Medos DeltaStream MDC console, a Medos Hilite 2400 LT oxygenator for the pediatric ECLS circuit, and a Medos Hilite 7000 LT oxygenator for the adult ECLS circuit. The circuit was primed with lactated Ringer's solution and human packed red blood cells (hematocrit 40%). Trials were conducted at various flow rates (pediatric circuit: 0.5 and 1L/min; adult circuit: 2 and 4L/min) under nonpulsatile and pulsatile modes (pulsatile amplitude: 1000–5000rpm [1000 rpm increments] for i‐cor pump, 500–2500rpm [500 rpm increments] for Medos pump) at 36°C. In an additional protocol, fresh whole blood was used to test hemolysis under nonpulsatile and pulsatile modes using the two pump systems in adult ECLS circuits. Under pulsatile mode, energy equivalent pressures (EEP) were always greater than mean pressures for the two systems. Total hemodynamic energy (THE) and surplus hemodynamic energy (SHE) levels delivered to the patient increased with increasing pulsatile amplitude and decreased with increasing flow rate. The i‐cor pump outperformed at low flow rates, but the Medos pump performed superiorly at high flow rates. There was no significant difference between two pumps in percentage of THE loss. The plasma free hemoglobin level was always higher in the Medos DP3 pulsatile group at 4 L/min compared to others. Pulsatile control algorithms of Medos and i‐cor consoles had great effects on pulsatility. Although high pulsatile amplitudes delivered higher levels of hemodynamic energy to the patient, the high rotational speeds increased the risk of hemolysis. Use of proper pulsatile amplitude settings and intermittent pulsatile mode are suggested to achieve better pulsatility and decrease the risk of hemolysis. Further optimized pulsatile control algorithms are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of Pulsatile Control Algorithms for Diagonal Pump on Hemodynamic Performance and Hemolysis

et al. 2018

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“…Madison Force et al of the Penn State Health Children's Hospital, Hershey, PA, USA, assessed the hemodynamic properties of the i‐cor ECG‐synchronized cardiac assist system for off‐label use as a short‐term cardiac assist device for neonatal and pediatric patients and compare nonpulsatile to pulsatile flow with different amplitudes. Energy equivalent pressure (EEP) was higher than mean pressure under pulsatile mode, and increased with increasing pseudo‐patient's pressure and flow rate while EEP was the same as the mean pressure under nonpulsatile mode.…”

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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“…13,14 Recently, there has been work showing the importance of applying pulsating flow to both implantable VAD systems and to short-term extracorporeal MCS systems, including cardiopulmonary bypass and temporary LV bypass systems. [15][16][17][18] The latter studies use indicators of equivalent energy pressure (EEP) and surplus haemodynamic energy (SHE) to assess the efficiency of pulsating systems. These indicators show the amount of additional energy transferred to the circulatory system from the pulsating flow.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic evaluation of the new pulsatile-flow generation method in vitro

et al. 2019

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Continuous-flow ventricular-assist devices are widely used to support patients with advanced heart failure, because continuous-flow ventricular-assist devices are more durable, have smaller sizes and have better survival rates for patients compared to the pulsatile-flow ventricular-assist devices. Nevertheless, continuous-flow ventricular-assist devices often cause complications such as gastrointestinal bleeding, haemorrhagic stroke, and aortic insufficiency and have a negative impact on the microcirculation for both long-time implantable and short-time extracorporeal systems. The aim of this study is the evaluation of the pulsatile-flow generation method in continuous-flow ventricular-assist device without pump speed changes. The method may be used for short-time extracorporeal continuous-flow mechanical circulatory support and long-time implantable mechanical circulatory support. A shunt with a controlled adjustable valve, that clamps periodically, is connected in parallel to the continuous-flow ventricular-assist device. We compared the continuous-flow ventricular-assist device operating with and without the shunt on the mock circulation loop. The continuous-flow ventricular-assist device–shunt system was connected according to the left ventricle–aorta circuit and worked in phase with the ventricle. Heart failure was simulated on the mock circulation circuit. Rotaflow (Maquet Inc.) was used as the continuous-flow pump. Haemolysis studies of the system for generating a pulse flow were carried out at a flow rate of 5 L/min and a pressure drop of 100 mm Hg. To compare the haemodynamic efficiency, we used the aortic pulsation index Ip, the equivalent energy pressure and the surplus haemodynamic energy. These indexes were higher in the pulsatile mode ( Ip – 4 times, equivalent energy pressure by 7.36% and surplus haemodynamic energy – 10 times), while haemolysis was the same. The normalised index of haemolysis was 0.0015 ± 0.001. The results demonstrate the efficiency of the pulsatile-flow generation method for continuous-flow ventricular-assist devices without impeller rotation rate changes.

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In Vitro Hemodynamic Evaluation of ECG‐Synchronized Pulsatile Flow Using i‐Cor Pump as Short‐Term Cardiac Assist Device for Neonatal and Pediatric Population

Cited by 18 publications

References 16 publications

Effects of Pulsatile Control Algorithms for Diagonal Pump on Hemodynamic Performance and Hemolysis

Effects of Pulsatile Control Algorithms for Diagonal Pump on Hemodynamic Performance and Hemolysis

Artificial Organs 2018: A Year in Review

Haemodynamic evaluation of the new pulsatile-flow generation method in vitro

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