Pulsatile Venoarterial Perfusion Using a Novel Synchronized Cardiac Assist Device Augments Coronary Artery Blood Flow During Ventricular Fibrillation

Cremers, Bodo; Link, Andreas; Werner, Christian; Gorhan, Holger; Simundic, Ivo; Matheis, G.; Scheller, Bruno; Böhm, Michael; Laufs, Ulrich

doi:10.1111/aor.12413

Cited by 31 publications

(39 citation statements)

References 19 publications

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“…In a separate recent study, other investigators have shown that this particular i-cor system with the highest possible quality of pulsatility settings was able to restore and significantly increase systemic coronary circulation during ventricular fibrillation in an adult swine model (17). However, the objective of this initial study is to evaluate whether ECG signal of regular and irregular cardiac rhythm can trigger pulsatile mode.…”

Section: Limitationsmentioning

confidence: 99%

Evaluation of a Novel Pulsatile Extracorporeal Life Support System Synchronized to the Cardiac Cycle: Effect of Rhythm Changes on Hemodynamic Performance

et al. 2015

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Arrhythmias are a frequent complication during extracorporeal life support (ECLS). A new ECLS system can provide pulsatile flow synchronized to the patient's intrinsic cardiac cycle based upon the R wave of the electrocardiogram (ECG). It is unclear how the occurrence of arrhythmias may alter the hemodynamic performance of the system. This in vitro study evaluated the effect of simulated arrhythmias on hemodynamics during R wave-triggered pulsatile ECLS. The ECLS circuit with an i-cor diagonal pump and iLA membrane ventilator was primed with whole blood at room temperature. Flow and pressure data were collected at 2.5 and 4 L/min for each condition using a customized data acquisition system. Pulsatile ECLS flow was R wave synchronized to an ECG simulator using 1:1, 1:2, and 1:3 assist ratios. Conditions tested included sinus rhythm at 45 and 90 bpm, supraventricular tachycardia (SVT), ventricular tachycardia (VT), and irregular rhythms such as ventricular fibrillation. Pulsatile mode was successfully triggered by ECG signals of normal sinus rhythm, SVT, VT, atrial fibrillation, atrial flutter, and ventricular bigeminy with assist ratios 1:1, 1:2, and 1:3. Regular rhythm at 90 bpm generated the best surplus hemodynamic energy (SHE). For SVT and VT, an assist ratio of 1:2 resulted in maximum pulsatile flow waveforms with optimal SHE at 2.5 L/min flow rate. At 4 L/min, SHE declined and the pressure drop increased independent of arrhythmia condition. Irregular rhythms still produced adequate pulsatile wave forms at lower pulsatile frequency. This study demonstrated the feasibility of generating pulsatile ECLS flow with the novel ECG-synchronized i-cor system during various simulated rhythms. The optimal rate for pulsatile flow was 90 bpm. During irregular rhythms, the lower pulsatile frequency was the more reliable synchronization mode for generating pulsatile flow.

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Section: Limitationsmentioning

confidence: 99%

Evaluation of a Novel Pulsatile Extracorporeal Life Support System Synchronized to the Cardiac Cycle: Effect of Rhythm Changes on Hemodynamic Performance

et al. 2015

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“…Yet ECLS itself also is prone to complications. Recent evidence supports that pulsatile flow in acute and chronic patients leads to increased perfusion of vital organs, better microcirculation, and overall improved patient outcomes compared with nonpulsatile flow (10)(11)(12)(13)(14)(15)(16)(17). As time goes on, new techniques in ECLS have been proven to decrease patient mortality and morbidity (4,6,7).…”

Section: Thoughts and Progress E134mentioning

confidence: 99%

“…The novel i-cor circuit incorporates a new diagonal pump that can produce excellent pulsatility (17,21,22). The novel i-cor circuit incorporates a new diagonal pump that can produce excellent pulsatility (17,21,22).…”

Section: Thoughts and Progress E134mentioning

confidence: 99%

“…Centrifugal pumps are currently the most popular pumps in ECLS circuits, with approximately 73% of institutions reporting clinical use in a survey by Palanzo et al (7). However, centrifugal pumps lack the ability to create pulsatile flow, which has been supported as a superior means of improving microcirculation and organ perfusion during acute and chronic support, leading to improved patient outcomes (10)(11)(12)(13)(14)(15)(16)(17). However, centrifugal pumps lack the ability to create pulsatile flow, which has been supported as a superior means of improving microcirculation and organ perfusion during acute and chronic support, leading to improved patient outcomes (10)(11)(12)(13)(14)(15)(16)(17).…”

mentioning

confidence: 99%

“…The Medos Deltastream DP3 diagonal pump is already being clinically used in Europe (20), but is not currently approved by the Food and Drug Administration (FDA) in the United States. While ECG synchronization is its newest feature, the pump also aims to create satisfactory pulsatile and nonpulsatile flow in the ECLS circuit (17,21,22). While ECG synchronization is its newest feature, the pump also aims to create satisfactory pulsatile and nonpulsatile flow in the ECLS circuit (17,21,22).…”

mentioning

confidence: 99%

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Impact of Pulsatility and Flow Rates on Hemodynamic Energy Transmission in an Adult Extracorporeal Life Support System

et al. 2015

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This study investigated the total hemodynamic energy (THE) and surplus hemodynamic energy transmission (SHE) of a novel adult extracorporeal life support (ECLS) system with nonpulsatile and pulsatile settings and varying pulsatility to define the most effective setting for this circuit. The circuit consisted of an i-cor diagonal pump (Xenios AG, Heilbronn, Germany), an XLung membrane oxygenator (Xenios AG), an 18 Fr Medos femoral arterial cannula (Xenios AG), a 23/25 Fr Estech RAP femoral venous cannula (San Ramon, CA, USA), 3/8 in ID × 140 cm arterial tubing, and 3/8 in ID × 160 cm venous tubing. Priming was done with lactated Ringer's solution and packed red blood cells (HCT 36%). The trials were conducted at flow rates 1-4 L/min (1 L/min increments) under nonpulsatile and pulsatile mode, with differential speed values 1000-4000 rpm (1000 rpm increments) at 36°. The pseudo patient's mean arterial pressure was kept at 100 mm Hg using a Hoffman clamp during all trials. Real-time flow and pressure data were collected using a custom-based data acquisition system. Mean pressures across the circuit increased with increasing flow rates, but increased insignificantly with increasing differential speed values. Mean pressure did not change significantly between pulsatile and nonpulsatile modes. Pulsatile flow created more THE than nonpulsatile flow at the preoxygenator site (P < 0.01). Of the different components of the circuit, the arterial cannula created the greatest THE loss. THE loss across the circuit ranged from 24.8 to 71.3%. Still, under pulsatile mode, more THE was delivered to the pseudo patient at low flow rates. No SHE was created with nonpulsatile flow, but SHE was created with pulsatile flow, and increased with increasing differential speed values. At lower flow rates (1-2 L/min), the arterial cannula contributed the most to SHE loss, but at higher flow rates the arterial tubing created the most SHE loss. The circuit pressure drop values across all flow rates were 33.1-246.5 mm Hg, and were slightly higher under pulsatile mode than nonpulsatile mode. The i-cor diagonal pump creates satisfactory pulsatile and nonpulsatile flows, and can easily change the pulsatile amplitude and energy transmission. The attributes of the XLung membrane oxygenator include low resistance, low energy loss, and low pressure drops at all flow rates and differential speed values. The arterial cannula created the highest pressure drop of all components of the circuit. Pulsatile flow improved the transmission of hemodynamic energy to the pseudo patient without significantly affecting the pressure drops across the circuit.

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Pediatric Extracorporeal Membrane Oxygenation and Mechanical Circulatory Assist Devices

et al. 2020

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Pulsatile Venoarterial Perfusion Using a Novel Synchronized Cardiac Assist Device Augments Coronary Artery Blood Flow During Ventricular Fibrillation

Cited by 31 publications

References 19 publications

Evaluation of a Novel Pulsatile Extracorporeal Life Support System Synchronized to the Cardiac Cycle: Effect of Rhythm Changes on Hemodynamic Performance

Evaluation of a Novel Pulsatile Extracorporeal Life Support System Synchronized to the Cardiac Cycle: Effect of Rhythm Changes on Hemodynamic Performance

Impact of Pulsatility and Flow Rates on Hemodynamic Energy Transmission in an Adult Extracorporeal Life Support System

Pediatric Extracorporeal Membrane Oxygenation and Mechanical Circulatory Assist Devices

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