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Heinsar S, Rozencwajg S, Suen J, Bassi GL, Malfertheiner M, Vercaemst L, Broman LM, Schmidt M, Combes A, Rätsep I, Fraser JF, Millar JE. Heart failure supported by veno-arterial extracorporeal membrane oxygenation (ECMO): a systematic review of pre-clinical models. Intensive Care Med Exp 2020; 8:16. [PMID: 32451698 PMCID: PMC7248156 DOI: 10.1186/s40635-020-00303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used to treat patients with refractory severe heart failure. Large animal models are developed to help understand physiology and build translational research projects. In order to better understand those experimental models, we conducted a systematic literature review of animal models combining heart failure and VA-ECMO. STUDIES SELECTION A systematic review was performed using Medline via PubMed, EMBASE, and Web of Science, from January 1996 to January 2019. Animal models combining experimental acute heart failure and ECMO were included. Clinical studies, abstracts, and studies not employing VA-ECMO were excluded. DATA EXTRACTION Following variables were extracted, relating to four key features: (1) study design, (2) animals and their peri-experimental care, (3) heart failure models and characteristics, and (4) ECMO characteristics and management. RESULTS Nineteen models of heart failure and VA-ECMO were included in this review. All were performed in large animals, the majority (n = 13) in pigs. Acute myocardial infarction (n = 11) with left anterior descending coronary ligation (n = 9) was the commonest mean of inducing heart failure. Most models employed peripheral VA-ECMO (n = 14) with limited reporting. CONCLUSION Among models that combined severe heart failure and VA-ECMO, there is a large heterogeneity in both design and reporting, as well as methods employed for heart failure. There is a need for standardization of reporting and minimum dataset to ensure translational research achieve high-quality standards.
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Affiliation(s)
- Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia. .,Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia
| | - Maximilian Malfertheiner
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Leen Vercaemst
- Department of Perfusion, University Hospital Gasthuisberg, Louven, Belgium
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Matthieu Schmidt
- Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Alain Combes
- Second Department of Intensive Care, North Estonia Medical Centre, Talinn, Estonia
| | - Indrek Rätsep
- Sorbonne Université, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Medical ICU, Pitié-Salpêtrière University Hospital, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Chermside, Brisbane, Australia.,Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
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Prasad A, Brehm CE, Goldenberg M, Ghodsizad A, Koerner MM, El-Banayosy A, Singbartl K. Early prediction of transition to durable mechanical circulatory support in patients undergoing peripheral veno-arterial extracorporeal membrane oxygenation for critical cardiogenic shock. Artif Organs 2019; 44:402-410. [PMID: 31660618 DOI: 10.1111/aor.13590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 01/02/2023]
Abstract
Peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) has gained increasing value in the management of patients with critical cardiogenic shock (cCS), allowing time for myocardial recovery. Failure of myocardial recovery has life-altering consequences: transition to durable mechanical circulatory support (dMCS), urgent heart transplantation, or withdrawal of support. Clinical factors controlling myocardial recovery under these circumstances remain largely unknown. Using a retrospective cohort, we developed a model for early prediction of transition to dMCS in patients undergoing pVA-ECMO for cCS. To promote myocardial recovery, our clinical management centered around left ventricular pressure unloading, that is, targeting pulmonary capillary wedge pressures (PCWP) ≤18 mm Hg. We collected demographic data, laboratory findings, inotrope use, and two-dimensional transthoracic echocardiography measurements, all limited to the first 72h of pVA-ECMO (D1-3). Out of 70 patients who were alive after pVA-ECMO, 27 patients underwent implantation of dMCS. There was no significant difference in survival to hospital discharge between patients with or without transition to dMCS. Ejection fractionD1-3 (per 10% increase, OR 0.37 [0.17-0.79]) and amount of inotropic supportD1-3 (OR 4.77 [1.6-14.18]) but neither myocardial wall tension nor PCWP emerged as significant predictors of transition to dMCS. Optimism-corrected c-index (0.90 [0.89-0.90]) revealed an excellent discriminative ability of our model. In summary, our model for early prediction of transition to dMCS in patients with cCS undergoing pVA-ECMO identifies indicators of inotropic state as relevant factors. Absence of markers for myocardial oxygen consumption or left ventricular pressure loading allows us to hypothesize sufficient cardiac unloading in our cohort with PCWP-targeted management.
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Affiliation(s)
- Amit Prasad
- Heart and Vascular Institute, Penn State Health, Hershey, PA, USA
| | | | | | - Ali Ghodsizad
- Miami Transplant Institute, University of Miami, Miami, FL, USA
| | - Michael M Koerner
- Advanced Cardiac Care and Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Aly El-Banayosy
- Advanced Cardiac Care and Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Kai Singbartl
- Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
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Huang CC, Hsu JC, Wu YW, Ke SR, Huang JH, Chiu KM, Liao PC. Implementation of extracorporeal membrane oxygenation before primary percutaneous coronary intervention may improve the survival of patients with ST-segment elevation myocardial infarction and refractory cardiogenic shock. Int J Cardiol 2018; 269:45-50. [DOI: 10.1016/j.ijcard.2018.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 06/03/2018] [Accepted: 07/03/2018] [Indexed: 11/15/2022]
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Insufficient left ventricular unloading after extracorporeal membrane oxygenation : A case-series observational study. Herz 2018; 45:186-191. [PMID: 29777285 DOI: 10.1007/s00059-018-4711-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a method widely used to support circulation in patients with fulminant myocarditis (FM). However, a common complication associated with ECMO is left ventricular (LV) overload. METHODS This case series observed the effects of intra-aortic balloon pump (IABP) and beta-blockers for the treatment of LV overload after ECMO. The cases of eight patients with FM who underwent ECMO from September 2009 to July 2016 were reviewed. RESULTS Six of the eight patients survived. After ECMO treatment, insufficient LV unloading occurred in six patients. Among these six patients, three experienced electrical storm but spontaneous circulation returned after interventions with beta-blockers and IABP. The survivors demonstrated full recovery of cardiac function. CONCLUSION Beta-blockers may prevent the occurrence of electrical storm, and IABP is feasible for the treatment of LV overload after ECMO application.
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Wang S, Spencer SB, Kunselman AR, Ündar A. Novel ECG-Synchronized Pulsatile ECLS System With Various Heart Rates and Cardiac Arrhythmias: An In Vitro Study. Artif Organs 2017; 41:55-65. [DOI: 10.1111/aor.12904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/30/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics, Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center
| | - Shannon B. Spencer
- Department of Pediatrics, Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center
| | | | - Akif Ündar
- Department of Pediatrics, Public Health and Sciences; Penn State Hershey Pediatric Cardiovascular Research Center
- Surgery and Bioengineering, Penn State Hershey College of Medicine, Penn State Milton S. Hershey Medical Center; Penn State Hershey Children's Hospital; Hershey PA USA
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Wang S, Krawiec C, Patel S, Kunselman AR, Song J, Lei F, Baer LD, Ündar A. Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems. Artif Organs 2015; 39:774-81. [DOI: 10.1111/aor.12466] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shigang Wang
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Conrad Krawiec
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
- Pediatric Critical Care Unit; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Sunil Patel
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
- Pediatric Cardiology; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health Sciences; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Jianxun Song
- Department of Microbiology & Immunology; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Fengyang Lei
- Department of Microbiology & Immunology; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Larry D. Baer
- Heart and Vascular Institute; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center; Department of Pediatrics; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
- Surgery and Bioengineering; Penn State Hershey College of Medicine; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Hershey PA USA
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Hu W, Chen L, Liu C, Hu W, Lu J, Zhu Y, Wang J, Liu B. Three cases of electrical storm in fulminant myocarditis treated by extracorporeal membrane oxygenation. Am J Emerg Med 2015; 33:606.e3-8. [DOI: 10.1016/j.ajem.2014.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/11/2014] [Indexed: 11/26/2022] Open
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Krawiec C, Wang S, Kunselman AR, Ündar A. Impact of pulsatile flow on hemodynamic energy in a Medos Deltastream DP3 pediatric extracorporeal life support system. Artif Organs 2013; 38:19-27. [PMID: 23826748 DOI: 10.1111/aor.12117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Medos Deltastream DP3 system is made up of a novel diagonal pump and hollow-membrane oxygenator that provides nonpulsatile and pulsatile flows for extracorporeal life support (ECLS). The objectives of this study are to (i) evaluate the efficacy of the hemodynamic energy provided by Medos Deltastream DP3 system in nonpulsatile and pulsatile mode and (ii) to evaluate the pulsatile mode under different frequencies. The experimental ECLS circuit was used in this study, primed with Ringer's lactate and packed red blood cells (hematocrit 35%). All trials were conducted at flow rates of 500, 1000, 1500, and 2000 mL/min with modified pulsatile frequencies of 60, 70, 80, and 90 bpm at 36°C. Simultaneous blood flow and pressures at the pre/postoxygenator and pre/postcannula sites were recorded for quantification of the pulsatile perfusion-generated energy-equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE). The experiments showed that under pulsatile flow conditions, at all flow rates and frequencies, (i) the EEP, SHE, and THE were significantly higher when compared with the nonpulsatile group and (ii) the pressure drop was minimal at lower flow rates and lower pulsatile frequencies but was significant when either the flow rate or the pulsatile frequency was increased. The Medos Deltastream DP3 System can provide nonpulsatile flow and physiologic quality pulsatile flow for pediatric ECLS. When the Medos DP3 pediatric ECLS system is used with pulsatile flow, there is more surplus hemodynamic energy and total hemodynamic energy than nonpulsatile flow.
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Affiliation(s)
- Conrad Krawiec
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA; Penn State Hershey Pediatric Cardiovascular Research Center, Department of Surgery and Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA; Penn State Hershey Pediatric Critical Care Unit, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA
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Bělohlávek J, Mlček M, Huptych M, Svoboda T, Havránek Š, Ošt'ádal P, Bouček T, Kovárník T, Mlejnský F, Mrázek V, Bělohlávek M, Aschermann M, Linhart A, Kittnar O. Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation. Crit Care 2012; 16:R50. [PMID: 22424292 PMCID: PMC3964801 DOI: 10.1186/cc11254] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/24/2012] [Accepted: 03/16/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is increasingly used in cardiac arrest (CA). Adequacy of carotid and coronary blood flows (CaBF, CoBF) and coronary perfusion pressure (CoPP) in ECMO treated CA is not well established. This study compares femoro-femoral (FF) to femoro-subclavian (FS) ECMO and intraaortic balloon counterpulsation (IABP) contribution based on CaBF, CoBF, CoPP, myocardial and brain oxygenation in experimental CA managed by ECMO. METHODS In 11 female pigs (50.3 ± 3.4 kg), CA was randomly treated by FF versus FS ECMO ± IABP. Animals under general anesthesia had undergone 15 minutes of ventricular fibrillation (VF) with ECMO flow of 5 to 10 mL/kg/min simulating low-flow CA followed by continued VF with ECMO flow of 100 mL/kg/min. CaBF and CoBF were measured by a Doppler flow wire, cerebral and peripheral oxygenation by near infrared spectroscopy. CoPP, myocardial oxygen metabolism and resuscitability were determined. RESULTS CaBF reached values > 80% of baseline in all regimens. CoBF > 80% was reached only by the FF ECMO, 90.0% (66.1, 98.6). Addition of IABP to FF ECMO decreased CoBF to 60.7% (55.1, 86.2) of baseline, P = 0.004. FS ECMO produced 70.0% (49.1, 113.2) of baseline CoBF, significantly lower than FF, P = 0.039. Addition of IABP to FS did not change the CoBF; however, it provided significantly higher flow, 76.7% (71.9, 111.2) of baseline, compared to FF + IABP, P = 0.026. Both brain and peripheral regional oxygen saturations decreased after induction of CA to 23% (15.0, 32.3) and 34% (23.5, 34.0), respectively, and normalized after ECMO institution. For brain saturations, all regimens reached values exceeding 80% of baseline, none of the comparisons between respective treatment approaches differed significantly. After a decline to 15 mmHg (9.5, 20.8) during CA, CoPP gradually rose with time to 68 mmHg (43.3, 84.0), P = 0 .003, with best recovery on FF ECMO. Resuscitability of the animals was high, both 5 and 60 minutes return of spontaneous circulation occured in eight animals (73%). CONCLUSIONS In a pig model of CA, both FF and FS ECMO assure adequate brain perfusion and oxygenation. FF ECMO offers better CoBF than FS ECMO. Addition of IABP to FF ECMO worsens CoBF. FF ECMO, more than FS ECMO, increases CoPP over time.
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Affiliation(s)
- Jan Bělohlávek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Mikuláš Mlček
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic
| | - Michal Huptych
- BioDat Research Group, Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Karlovo namesti 13, Prague 2, 121 35, Czech Republic
| | - Tomáš Svoboda
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic
| | - Štěpán Havránek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Petr Ošt'ádal
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2/37, Prague 5, 150 30, Czech Republic
| | - Tomáš Bouček
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Tomáš Kovárník
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - František Mlejnský
- 2nd Department of Surgery, Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Vratislav Mrázek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Marek Bělohlávek
- Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Michael Aschermann
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Aleš Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic
| | - Otomar Kittnar
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00, Czech Republic
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Feng Qiu, Khan S, Talor J, Kunselman A, Ündar A. Evaluation of two pediatric polymethyl pentene membrane oxygenators with pulsatile and non-pulsatile perfusion. Perfusion 2011; 26:229-37. [DOI: 10.1177/0267659110396116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This experiment sought to compare two polymethyl pentene (PMP) hollow-fiber membrane oxygenators: the Medos HILITE 2400 LT and the Maquet Quadrox-iD Pediatric in terms of transmembrane pressure gradients and hemodynamic energy preservation under both pulsatile and non-pulsatile conditions. Methods: A simulated pediatric extracorporeal life support (ECLS) circuit was used to test these two oxygenators. The circuit consisted of a roller pump, ¼ inch tubing for both arterial and venous lines, an oxygenator, and a venous reservoir served as a pseudo-patient. Three pressure transducers were placed upstream and downstream of the oxygenator and the distal arterial line. The experimental system was primed with lactated Ringer’s solution and packed human red blood cells to maintain a hematocrit of 40%.The total volume was 600 ml, including the 350 ml volume of the pseudo-patient.The tests were performed at six flow rates (250, 500, 750, 1000, 1250, 1500 ml/min) and three distal arterial line pressures (MAP) (60, 80, 100 mmHg), under both pulsatile and non-pulsatile perfusion modes.The temperature was kept constant at 37°C for all tests. Results: Both oxygenators had adequate performances in pressure drop and hemodynamic energy preservation. There were no significant differences between pre- and post-oxygenators for mean pressure (MP), energy equivalent pressure (EEP) and total hemodynamic energy (THE). During the pulsatile perfusion mode, the HILITE 2400 LT retained a greater percentage of surplus hemodynamic energy (SHE) across the oxygenator. Conclusions: Both the Quadrox-iD Pediatric and HILITE 2400LT PMP membrane oxygenators are suitable for pediatric ECLS therapy under both non-pulsatile and pulsatile perfusion. An optimized combination of flow rate and MAP should be achieved in order to deliver the maximal pulsatile energy in the extracorporeal circuit.
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Affiliation(s)
- Feng Qiu
- Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Sameer Khan
- Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Jonathan Talor
- Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Allan Kunselman
- Public Health and Sciences, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA, Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA, Department of Bioengineering Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn
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George RS, Sabharwal NK, Webb C, Yacoub MH, Bowles CT, Hedger M, Khaghani A, Birks EJ. Echocardiographic assessment of flow across continuous-flow ventricular assist devices at low speeds. J Heart Lung Transplant 2010; 29:1245-52. [PMID: 20688540 DOI: 10.1016/j.healun.2010.05.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/29/2010] [Accepted: 05/31/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Testing of native myocardial function in patients with continuous-flow pumps is challenging as reduction/cessation of the pump could result in regurgitation, although the amount and significance of this regurgitation remains unknown. The aim of this study was to determine the optimal speed at which to assess the native left ventricular (LV) function and the physiologic response to speed reduction. METHODS Fifteen male patients with a HeartMate II (HMII) device were studied prospectively on 46 occasions. Measurements were performed serially at three device speed settings: baseline speed; 6,000 rpm; and either 5,000 rpm (Group A) or 4,000 rpm (Group B). The device's forward and reverse velocity (Vmax(f), Vmax(r)), forward and reverse velocity time integral (VTI(f), VTI(r)) and blood volume (BV) were also measured using Doppler with LV echocardiographic parameters and peripheral hemodynamics. RESULTS No adverse incidents were reported. Speed reduction to 6,000 rpm resulted in a significant decrease in Vmax(f), VTI(f) and BV. There was no significant difference in either forward or reverse flow with further speed reduction in either group. Speed reduction to <6,000 rpm did not have a significant effect on LV loading. CONCLUSIONS Speed reduction in patients with the HMII device is safe. There was no difference between 6,000 rpm and lower speeds, suggesting that 6,000 rpm is sufficient to assess native myocardial function. The absence of significant retrograde filling suggests that LV loading is a physiologic response to speed reduction at 6,000 rpm.
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Affiliation(s)
- Robert S George
- Mechanical Circulatory Support Department, Imperial College, Uxbridge, UK
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Haines N, Wang S, Myers JL, Ãndar A. Comparison of Two Types of Neonatal Extracorporeal Life Support Systems With Pulsatile and Nonpulsatile Flow. Artif Organs 2009; 33:958-66. [DOI: 10.1111/j.1525-1594.2009.00934.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhang L, Yang M, Song Y, Sun Z, Peng Y, Qu K, Zhu H. Antihypertensive effect of 3,3,5,5-tetramethyl-4-piperidone, a new compound extracted from Marasmius androsaceus. JOURNAL OF ETHNOPHARMACOLOGY 2009; 123:34-39. [PMID: 19429336 DOI: 10.1016/j.jep.2009.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 01/14/2009] [Accepted: 02/16/2009] [Indexed: 05/27/2023]
Abstract
AIM OF THE STUDY To evaluate the antihypertensive effect of 3,3,5,5-tetramethyl-4-piperidone (TMP), a new compound extracted from Marasmius androsaceus. Besides, the hemodynamic profiles and pertinent mechanism of the compound were explored. MATERIALS AND METHODS Acute and chronic antihypertensive effects of TMP were examined in spontaneous hypertensive rats (SHRs) and reno-hypertensive rats (two kidneys one clip model, 2K1C). Anesthetized dogs were used to evaluate the hemodynamic effects of TMP. Moreover, the cat nictitating membrane response was used to test the ganglionic blocking property of TMP. RESULTS TMP (2.5, 5 and 10mg/kg, p.o.) notably reduced the blood pressure of SHR in 30 min. Two-week administration of TMP (2.5, 5 and 10mg/kg, p.o.) also decreased the blood pressure of 2K1C rats. TMP (30 mg/kg, i.v.) abolished the response of the nictitating membrane induced by preganglionic stimulation. The results of hemodynamic study in anesthetized dogs showed that, except for the reduction in blood pressure and left ventricular work, no other changes were detected. The results of heart rate variability analysis indicated an intact sympathetic-vagal balance after TMP treatment. CONCLUSIONS TMP is a new antihypertensive compound, and the effect is partially related to ganglionic blocking.
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Affiliation(s)
- Ling Zhang
- Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Ministry of Education, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, PR China
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