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Kanagarajan D, Heinsar S, Gandini L, Suen JY, Dau VT, Pauls J, Fraser JF. Preclinical Studies on Pulsatile Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review. ASAIO J 2023; 69:e167-e180. [PMID: 36976324 DOI: 10.1097/mat.0000000000001922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Refractory cardiogenic shock is increasingly being treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO), without definitive proof of improved clinical outcomes. Recently, pulsatile V-A ECMO has been developed to address some of the shortcomings of contemporary continuous-flow devices. To describe current pulsatile V-A ECMO studies, we conducted a systematic review of all preclinical studies in this area. We adhered to PRISMA and Cochrane guidelines for conducting systematic reviews. The literature search was performed using Science Direct, Web of Science, Scopus, and PubMed databases. All preclinical experimental studies investigating pulsatile V-A ECMO and published before July 26, 2022 were included. We extracted data relating to the 1) ECMO circuits, 2) pulsatile blood flow conditions, 3) key study outcomes, and 4) other relevant experimental conditions. Forty-five manuscripts of pulsatile V-A ECMO were included in this review detailing 26 in vitro , two in silico , and 17 in vivo experiments. Hemodynamic energy production was the most investigated outcome (69%). A total of 53% of studies used a diagonal pump to achieve pulsatile flow. Most literature on pulsatile V-A ECMO focuses on hemodynamic energy production, whereas its potential clinical effects such as favorable heart and brain function, end-organ microcirculation, and decreased inflammation remain inconclusive and limited.
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Affiliation(s)
- Dhayananth Kanagarajan
- From the Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Engineering and Built Environment, Griffith University, Gold Coast, Queensland, Australia
| | - Silver Heinsar
- From the Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Lucia Gandini
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jacky Y Suen
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Van Thanh Dau
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jo Pauls
- From the Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Engineering and Built Environment, Griffith University, Gold Coast, Queensland, Australia
| | - John F Fraser
- From the Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Engineering and Built Environment, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Kurihara C, Walter JM, Karim A, Thakkar S, Saine M, Odell DD, Kim S, Tomic R, Wunderink RG, Budinger GRS, Bharat A. Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation. Ann Thorac Surg 2020; 110:1209-1215. [PMID: 32173339 DOI: 10.1016/j.athoracsur.2020.02.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/18/2019] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly being used for acute respiratory distress syndrome and as a bridge to lung transplantation. After initiation of venovenous ECMO, systemic anticoagulation therapy is traditionally administered and can cause bleeding diathesis. Here, we investigated whether venovenous ECMO can be administered without continuous systemic anticoagulation administration for patients with acute respiratory distress syndrome. METHODS This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through February 2019. Overall, 38 patients received low levels of continuous systemic anticoagulation (AC+) whereas the subsequent 36 patients received standard venous thromboprophylaxis (AC-). Published Extracorporeal Life Support Organization guidelines were used for the definition of outcomes and complications. RESULTS Overall, survival was not different between the two groups (P = .58). However, patients in the AC+ group had higher rates of gastrointestinal bleeding (28.9%, vs AC- group 5.6%; P < .001). The events per patient-day of gastrointestinal bleeding was 0.00025 in the AC- group and 0.00064 in the AC+ group (P < .001). In addition, oxygenator dysfunction was increased in the AC+ group (28.9% and 0.00067 events per patient-day, vs AC- 11.1% and 0.00062 events per patient-day; P = .02). Furthermore, the AC+ group received more transfusions: packed red blood cells, AC+ group 94.7% vs AC- group 55.5% (P < .001); fresh frozen plasma, AC+ 60.5% vs AC- 16.6% (P = .001); and platelets, AC+ 84.2% vs AC- 27.7% (P < .001). There was no circuit thrombosis in either groups throughout the duration of ECMO support. CONCLUSIONS Our results suggest that venovenous ECMO can be safely administered without continuous systemic anticoagulation therapy. This approach may be associated with reduced bleeding diathesis and need for blood transfusions.
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Affiliation(s)
- Chitaru Kurihara
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James M Walter
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Azad Karim
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanket Thakkar
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Saine
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Odell
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel Kim
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rade Tomic
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G Wunderink
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - G R Scott Budinger
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Spencer SB, Wang S, Woitas K, Glass K, Kunselman AR, Ündar A. In Vitro Evaluation of an Alternative Neonatal Extracorporeal Life Support Circuit on Hemodynamic Performance and Bubble Trap. Artif Organs 2016; 41:17-24. [PMID: 27735070 DOI: 10.1111/aor.12748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/04/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
The objective of this study was to evaluate an alternative neonatal extracorporeal life support (ECLS) circuit with a RotaFlow centrifugal pump and Better-Bladder (BB) for hemodynamic performance and gaseous microemboli (GME) capture in a simulated neonatal ECLS system. The circuit consisted of a Maquet RotaFlow centrifugal pump, a Quadrox-iD Pediatric diffusion membrane oxygenator, 8 Fr arterial cannula, and 10 Fr venous cannula. A "Y" connector was inserted into the venous line to allow for comparison between BB and no BB. The circuit and pseudopatient were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 35%). All hemodynamic trials were conducted at flow rates ranging from 100 to 600 mL/min at 36°C. Real-time pressure and flow data were recorded using a data acquisition system. For GME testing, 0.5 cc of air was injected via syringe into the venous line. GME were detected and characterized with or without the BB using the Emboli Detection and Classification Quantifier (EDAC) System. Trials were conducted at flow rates ranging from 200 to 500 mL/min. The hemodynamic energy data showed that up to 75.2% of the total hemodynamic energy was lost from the circuit. The greatest pressure drops occurred across the arterial cannula and increased with increasing flow rate from 10.1 mm Hg at 100 mL/min to 114.3 mm Hg at 600 mL/min. The EDAC results showed that the BB trapped a significant amount of the GME in the circuit. When the bladder was removed, GME passed through the pump head and the oxygenator to the arterial line. This study showed that a RotaFlow centrifugal pump combined with a BB can help to significantly decrease the number of GME in a neonatal ECLS circuit. Even with this optimized alternative circuit, a large percentage of the total hemodynamic energy was lost. The arterial cannula was the main source of resistance in the circuit.
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Affiliation(s)
- Shannon B Spencer
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Shigang Wang
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Karl Woitas
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | - Kristen Glass
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA
| | | | - Akif Ündar
- 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
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Onan İS, Haydin S, Ündar A, Yalındağ-Öztürk MN, Demirkol D, Kalkan G, Ceyran H, Atay Y, Şaşmazel A, Karacı AR, Şevketoğlu E, Köroğlu T, Altın HF, Yazıcı P, Yıldızdaş D, Çicek AE, Ödemiş E, Akçevin A, Bakır İ. A multidisciplinary approach to expand the use of pediatric ECLS systems in Turkey. Artif Organs 2015; 39:7-13. [PMID: 25626574 DOI: 10.1111/aor.12374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- İsmihan Selen Onan
- Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Division, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey
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Wang S, Evenson A, Chin BJ, Kunselman AR, Ündar A. Evaluation of Conventional Nonpulsatile and Novel Pulsatile Extracorporeal Life Support Systems in a Simulated Pediatric Extracorporeal Life Support Model. Artif Organs 2014; 39:E1-9. [DOI: 10.1111/aor.12290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shigang Wang
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Alissa Evenson
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Brian J. Chin
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health Sciences; Penn State Hershey College of Medicine; Hershey PA USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center; Penn State Hershey Children's Hospital; Penn State Milton S. Hershey Medical Center; Department of Pediatrics; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Surgery; Penn State Milton S. Hershey Medical Center; Penn State Hershey College of Medicine; Hershey PA USA
- Department of Bioengineering; College of Engineering; Pennsylvania State University; University Park PA USA
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Ündar A, Wang S, Palanzo DA. Impact of Polymethylpentene Oxygenators on Outcomes of All Extracorporeal Life Support Patients in the United States. Artif Organs 2013; 37:1080-1. [DOI: 10.1111/aor.12242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Akif Ündar
- Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Departments of Pediatrics, Surgery and Bioengineering, Pediatric Cardiovascular Research Center; Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - David A. Palanzo
- Heart and Vascular Institute, 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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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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Wang S, Durandy Y, Kunselman AR, Ündar A. A Nonocclusive, Inexpensive Pediatric Pulsatile Roller Pump for Cardiopulmonary Bypass, Extracorporeal Life Support, and Left/Right Ventricular Assist Systems. Artif Organs 2013; 37:48-56. [DOI: 10.1111/aor.12026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics, Department of Surgery and Bioengineering; 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; PA; USA
| | - Yves Durandy
- Institut Cardiovasculaire Paris-Sud; Massy; France
| | - Allen R. 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; PA; USA
| | - Akif Ündar
- Department of Pediatrics, Department of Surgery and Bioengineering; 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; PA; USA
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Rambaud J, Guilbert J, Guellec I, Renolleau S. A pilot study comparing two polymethylpentene extracorporeal membrane oxygenators. Perfusion 2012; 28:14-20. [PMID: 22918934 DOI: 10.1177/0267659112457970] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We compared two polymethylpentene oxygenators being used in our unit: the Maquet Quadrox-iD paediatric and the Medos Hilite 800LT. STUDY DESIGN A mono-centric, prospective pilot study was conducted on ten consecutive newborn patients who had been admitted to our hospital service for extracorporeal circulation (EC) treatment. We examined the rate of oxygen transfer, the CO2 removal capacity and the average sweep gas flow required to produce this result. We also assessed the disturbances of haemostasis, the need for labile blood products and the membrane oxygenator lifetime and cost of use. CONCLUSIONS According to our study, it seems to us that Medos Hilite 800LT membrane oxygenators demonstrate greater oxygen transfer and CO2 removal capacity than Maquet Quadrox-iD paediatric membrane oxygenators, at a similar cost. These results lead us to conclude that it is reasonable to continue using Medos Hilite 800LT membrane oxygenators. A broader comparison study would be necessary in order to support these initial results.
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Affiliation(s)
- J Rambaud
- Paediatric Intensive Care Unit, Armand-Trousseau Children's Hospital APHP (Paris Hospitals Public Assistance) UPMC (Pierre and Marie Curie University, Paris VI) Paris, France
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Reed-Thurston D, Qiu F, Ündar A, Haidet KK, Shenberger J. Pediatric and Neonatal Extracorporeal Life Support Technology Component Utilization: Are US Clinicians Implementing New Technology? Artif Organs 2012; 36:607-15. [DOI: 10.1111/j.1525-1594.2012.01445.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ündar A, Haydin S, Yivli P, Weaver B, Pauliks L, Cicek AE, Erek E, Saşmazel A, Ağirbaşli MA, Alkan-Bozkaya T, Akçevin A, Bakir I. Istanbul Symposiums on Pediatric Extracorporeal Life Support Systems. Artif Organs 2011; 35:983-8. [DOI: 10.1111/j.1525-1594.2011.01368.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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