1
|
Ahmad F, Cheema TA, Rehman K, Ullah M, Jamil M, Park CW. Hemodynamic performance evaluation of neonatal ECMO double lumen cannula using fluid-structure interaction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3706. [PMID: 37039384 DOI: 10.1002/cnm.3706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/30/2022] [Accepted: 03/19/2023] [Indexed: 06/07/2023]
Abstract
Extra corporeal membrane oxygenation (ECMO) is an artificial oxygenation facility, employed in situations of cardio-pulmonary failure. Some diseases i.e., acute respiratory distress syndrome, pulmonary hypertension, corona virus disease (COVID-19) etc. affect oxygenation performance of the lungs thus requiring the need of artificial oxygenation. Critical care teams used ECMO technique during the COVID-19 pandemic to support the heart and lungs of COVID-19 patients who had an acute respiratory or cardiac failure. Double Lumen Cannula (DLC) is one of the most critical components of ECMO as it resides inside the patient and, connects patient with external oxygenation circuit. DLC facilitates delivery and drainage of blood from the patient's body. DLC is characterized by delicate balance of internal and external flows inside a limited space of the right atrium (RA). An optimal performance of the DLC necessitates structural stability under biological and hemodynamic loads, a fact that has been overlooked by previously published studies. In the past, many researchers experimentally and computationally investigated the hemodynamic performance of DLC by employing Eulerian approach, which evaluate instantaneous blood damage without considering blood shear exposure history (qualitative assessment only). The present study is an attempt to address the aforementioned limitations of the previous studies by employing Lagrangian (quantitative assessment) and incorporating the effect of fluid-structure interaction (FSI) to study the hemodynamic performance of neonatal DLC. The study was performed by solving three-dimensional continuity, momentum, and structural mechanics equation(s) by numerical methods for the blood flow through neonatal DLC. A two-way coupled FSI analysis was performed to analyze the effect of DLC structural deformation on its hemodynamic performance. Results show that the return lumen was the most critical section with maximum pressure drop, velocity, shear stresses, and blood damage. Recirculation and residence time of blood in the right atrium (RA) increases with increasing blood flow rates. Considering the structural deformation has led to higher blood damage inside the DLC-atrium system. Maximum Von-Mises stress was present on the side edges of the return lumen that showed direct proportionality with the blood flow rate.
Collapse
Affiliation(s)
- Faiq Ahmad
- Faculty of Mechanical Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Taqi Ahmad Cheema
- Faculty of Mechanical Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Khawar Rehman
- Department of Civil and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea
- Department of Civil Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Minhaj Ullah
- Faculty of Mechanical Engineering, GIK Institute of Engineering Sciences and Technology, Topi, 23460, KPK, Pakistan
| | - Muhammad Jamil
- Analysis Group, Starfish Medical, 455 Boleskine Rd, Victoria, British Columbia, Canada
- Department of Mechanical Engineering, KoÇ University, Sariyar, Istanbul, 34450, Turkey
| | - Cheol Woo Park
- School of Mechanical Engineering, Kyungpook National University, 80 Daehak-Ro, Buk-Gu, Daegu, 41566, South Korea
| |
Collapse
|
2
|
In Vivo Suction Pressures of Venous Cannulas During Veno-venous Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:1372-1378. [PMID: 35184088 DOI: 10.1097/mat.0000000000001668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Extracorporeal lung support includes the risk of hemolysis due to suction pressures. Manufacturers measure the negative suction pressure across drainage cannulas for their products in vitro using water. Clinical experience suggests that hemolysis occurs in vivo already at much lower flow rates. The aim of this study was to analyze the in vivo suction pressure for veno-venous extracorporeal membrane oxygenation (VV-ECMO) cannulas. Prospective, observational study at a tertiary-care intensive care unit: 15 patients on VV-ECMO for severe ARDS were prospectively included. In vitro , the 25 Fr drainage cannula pressure drops below a critical level of around -100 mm Hg at a flow rate of 7.9 L/min, the 23 Fr drainage cannula at 6.6 L/min. In the clinical setting, critical suction pressures were reached at much lower flow rates (5.5 and 4.7 L/min; p < 0.0001, nonlinear regression). The in vitro data largely overestimate the safely achievable flow rates in daily clinical practice by 2.4 L/min (or 44%, 25 Fr) and 1.9 L/min (or 41%, 23 Fr). In vivo measurement of suction pressure of venous drainage cannulas differed significantly from in vitro derived measurements as the latter largely underestimate the resulting suction pressure.
Collapse
|
3
|
Stephens AF, Wickramarachchi A, Burrell AJC, Bellomo R, Raman J, Gregory SD. The Hemodynamics of Small Arterial Return Cannulae for Venoarterial Extracorporeal Membrane Oxygenation. Artif Organs 2022; 46:1068-1076. [PMID: 35049072 DOI: 10.1111/aor.14179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (ECMO) provides mechanical support for critically ill patients with cardiogenic shock. Typically, the size of the arterial return cannula is chosen to maximize flow. However, smaller arterial cannulae may reduce cannula-related complications and be easier to insert. This in vitro study quantified the hemodynamic effect of different arterial return cannula sizes in a simulated acute heart failure patient. METHODS Baseline support levels were simulated with a 17 Fr arterial cannula in an ECMO circuit attached to a cardiovascular simulator with targeted partial (2.0 L/min ECMO flow, 60-65 mmHg mean aortic pressure - MAP) and targeted full ECMO support (3.5 L/min ECMO flow and 70-75 mmHg MAP). Return cannula size was varied (13-21 Fr), and hemodynamics were recorded while keeping ECMO pump speed constant and adjusting pump speed to restore desired support levels. RESULTS Minimal differences in hemodynamics were found between cannula sizes in partial support mode. A maximum pump speed change of +600 rpm was required to reach the support target and arterial cannula inlet pressure varied from 79 (21 Fr) to 224 mmHg (13 Fr). The 15 Fr arterial cannula could provide the target full ECMO support at the targeted hemodynamics; however, the 13 Fr cannula could not due to the high resistance associated with the small diameter. CONCLUSIONS A 15 Fr arterial return cannula provided targeted partial and full ECMO support to a simulated acute heart failure patient. Balancing reduced cannula size and ECMO support level may improve patient outcomes by reducing cannula-related adverse events.
Collapse
Affiliation(s)
- Andrew F Stephens
- Cardio-respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | - Avishka Wickramarachchi
- Cardio-respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| | | | - Rinaldo Bellomo
- Intensive Care Unit, Austin Hospital, Melbourne, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia.,Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Jaishankar Raman
- Cardiothoracic Surgery, University of Melbourne, Melbourne, Australia
| | - Shaun D Gregory
- Cardio-respiratory Engineering and Technology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Australia
| |
Collapse
|
4
|
Ündar A. Evidence-based translational research approach may help to select the best femoral arterial cannula for adolescent/adult extracorporeal life support population. Perfusion 2020; 36:322-323. [PMID: 32757715 DOI: 10.1177/0267659120947376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
5
|
Ündar A. Pressure and flow properties of dual-lumen cannulae for extracorporeal membrane oxygenation. Perfusion 2020; 35:745-746. [PMID: 32627656 DOI: 10.1177/0267659120937546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery, and Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
6
|
Strunina S, Hozman J, Ostadal P. The peripheral cannulas in extracorporeal life support. ACTA ACUST UNITED AC 2019; 64:127-133. [PMID: 29648990 DOI: 10.1515/bmt-2017-0107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 03/12/2018] [Indexed: 11/15/2022]
Abstract
Femoral cannulation is a minimally invasive method which is an alternative method for central cannulation. This review focuses on the parameters and features of the available peripheral cannulas. Nowadays there exist many peripheral cannulas in a variety of sizes, configurations and lengths to meet the specific needs of the patients. Modern cannulas are strong, thin-walled and one piece reinforced constructions. Furthermore, modern cannulas are manufactured from a biocompatible material and surface coatings are applied to the cannulas to reduce the activation of the clotting. When peripheral cannulas are applied, bleeding, thrombosis and hemolysis are the most common complications.
Collapse
Affiliation(s)
- Svitlana Strunina
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Nám. Sítná 3105, 272 01Kladno, Czech Republic
| | - Jiri Hozman
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Nám. Sítná 3105, 272 01Kladno, Czech Republic
| | - Petr Ostadal
- Cardiovascular Center, Na Homolce Hospital, Roentgenova 2/37, 15030 Prague, Czech Republic
| |
Collapse
|
7
|
Wang S, Force M, Kunselman AR, Palanzo D, Brehm C, Ündar A. Hemodynamic Evaluation of Avalon Elite Bi-Caval Dual Lumen Cannulas and Femoral Arterial Cannulas. Artif Organs 2018; 43:41-53. [DOI: 10.1111/aor.13318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shigang Wang
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Madison Force
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Department of Public Health and Sciences; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - David Palanzo
- Department of Perfusion; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Christoph Brehm
- Department of Heart and Vascular Institute; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Health Pediatric Cardiovascular Research Center; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
- Department of Surgery and Bioengineering; Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital; Hershey PA USA
| |
Collapse
|
8
|
Glass K, Trivedi P, Wang S, Woitas K, Kunselman AR, Ündar A. Building a Better Neonatal Extracorporeal Life Support Circuit: Comparison of Hemodynamic Performance and Gaseous Microemboli Handling in Different Pump and Oxygenator Technologies. Artif Organs 2017; 41:392-400. [DOI: 10.1111/aor.12908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/20/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Kristen Glass
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
- Neonatal Intensive Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Payal Trivedi
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
- Neonatal Intensive Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Karl Woitas
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Allen R. Kunselman
- Public Health and Sciences, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital; Hershey PA USA
- 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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Clark JB, Wang S, Palanzo DA, Wise R, Baer LD, Brehm C, Ündar A. Current Techniques and Outcomes in Extracorporeal Life Support. Artif Organs 2015; 39:926-30. [DOI: 10.1111/aor.12527] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Joseph B. Clark
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Shigang Wang
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - David A. Palanzo
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Robert Wise
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Larry D. Baer
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Christoph Brehm
- Penn State Hershey Heart and Vascular Institute; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| | - Akif Ündar
- Department of Pediatrics; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Surgery; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
- Department of Bioengineering; Penn State Hershey Pediatric Cardiovascular Research Center; Penn State College of Medicine; Penn State Hershey Children's Hospital; 500 University Drive, Mail Code 850 Hershey PA 17033-0850 USA
| |
Collapse
|
11
|
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Adedayo P, Wang S, Kunselman AR, Ündar A. Impact of Pulsatile Flow Settings on Hemodynamic Energy Levels Using the Novel Diagonal Medos DP3 Pump in a Simulated Pediatric Extracorporeal Life Support System. World J Pediatr Congenit Heart Surg 2014; 5:440-8. [DOI: 10.1177/2150135114526760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/10/2014] [Indexed: 11/15/2022]
Abstract
Background: The objective of this study was to evaluate the pump performance of the novel diagonal Medos Deltastream DP3 diagonal pump (MEDOS Medizintechnik AG, , Stolberg, Germany) under nonpulsatile to pulsatile mode with varying differential speed values in a simulated pediatric extracorporeal life support system. Methods: The experimental circuit consisted of a Medos Deltastream DP3 pump head and console, a Medos Hilite 2400 LT hollow fiber membrane oxygenator (MEDOS Medizintechnik AG), a 14F Medtronic DLP arterial cannula (Medtronic Inc, Minnesota), and a 20F Terumo TenderFlow Pediatric venous return cannula (Terumo Corporation, Michigan). Trials were conducted at flow rates ranging from 500 mL/min to 2,000 mL/min (500 mL/min increments) and pulsatile differential speed values ranging from 500 rpm to 2,500 rpm (500 rpm increments) using human blood (hematocrit 35%). The postcannula pressure was maintained constantly at 60 mm Hg. Real-time pressure and flow data were recorded using a custom-made data acquisition system and Labview software. Results: Under all experimental conditions, pulsatile flow (P) generated significantly greater energy equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE) than those of nonpulsatile flow (NP). Under NP, SHE was zero. Higher differential speed values generated greater EEP, SHE, and THE values. There was little variation in the oxygenator pressure drop and the cannula pressure drop in P, compared to NP. Conclusions: The novel Medos Deltastream DP3 diagonal pump is able to generate physiological quality of P, without backflow. With increased differential rpm, the pump generated greater EEP, SHE, and THE. Physiological quality of pulsatility may be associated with better microcirculation because of greater EEP, SHE, and THE.
Collapse
Affiliation(s)
- Pelumi Adedayo
- Department of Pediatrics, 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
| | - Shigang Wang
- Department of Pediatrics, 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
| | - Allen R. Kunselman
- Department of Public Health and Sciences, 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
| | - Akif Ündar
- Department of Pediatrics, 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
- 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
| |
Collapse
|
13
|
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
| |
Collapse
|
14
|
Menon PG, Antaki JF, Undar A, Pekkan K. Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures. Ann Biomed Eng 2013; 41:2588-602. [PMID: 23817768 DOI: 10.1007/s10439-013-0857-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
Poor perfusion of the aortic arch is a suspected cause for peri- and post-operative neurological complications associated with cardiopulmonary bypass (CPB). High-speed jets from 8 to 10FR pediatric/neonatal cannulae delivering ~1 L/min of blood can accrue sub-lethal hemolytic damage while also subjecting the aorta to non-physiologic flow conditions that compromise cerebral perfusion. Therefore, we emphasize the importance of cannulation strategy and hypothesize engineering better CPB perfusion through a redesigned aortic cannula tip. This study employs computational fluid dynamics to investigate novel diffuser-tipped aortic cannulae for shape sensitivity to cerebral perfusion, in an in silico cross-clamped aortic arch model modeled with fixed outflow resistances. 17 parametrically altered configurations of an 8FR end-hole and several diffuser cone angled tips in combination with jet incidence angles toward or away from the head-neck vessels were studied. Experimental pressure-flow characterizations were also conducted on these cannula tip designs. An 8FR end-hole aortic cannula delivering 1 L/min along the transverse aortic arch was found to give rise to backflow from the brachicephalic artery (BCA), irrespective of angular orientation, for the chosen ascending aortic insertion location. Parametric alteration of the cannula tip to include a diffuser cone angle (tested up to 7°) eliminated BCA backflow for any tested angle of jet incidence. Experiments revealed that a 1 cm long 10° diffuser cone tip demonstrated the best pressure-flow performance improvement in contrast with either an end-hole tip or diffuser cone angles greater than 10°. Performance further improved when the diffuser was preceded by an expanded four-lobe swirl inducer attachment-a novel component. In conclusion, aortic cannula orientation is crucial in determining net head-neck perfusion but precise angulations and insertion-depths are difficult to achieve practically. Altering the cannula tip to include a diffuser cone angle has been shown for the first time to have potential in ensuring a net positive outflow at the BCA. Cannula insertion distanced from the BCA inlet may also avoid backflow owing to the Venturi effect, but the diffuser tipped cannula design presents a promising solution to mitigate this issue irrespective of in vivo cannula tip orientation.
Collapse
Affiliation(s)
- Prahlad G Menon
- Department of Biomedical Engineering, Carnegie Mellon University, 700 Technology Drive, #4319, Pittsburgh, PA, 15219, USA
| | | | | | | |
Collapse
|
15
|
Menon PG, Teslovich N, Chen CY, Undar A, Pekkan K. Characterization of neonatal aortic cannula jet flow regimes for improved cardiopulmonary bypass. J Biomech 2013. [DOI: 10.1016/j.jbiomech.2012.10.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
16
|
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.
Collapse
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
| | | | | | | |
Collapse
|
17
|
Abstract
INTRODUCTION The field of extracorporeal life support, which has focused predominantly on extracorporeal membrane oxygenation in the past, is undergoing rapid expansion following years of stagnation as newer devices and improved technology have become available. Additionally, new cannulae and cannulation techniques have allowed extracorporeal life support to be expanded to many groups who would have been excluded from support in the past. REVIEW This update will review the current state of the art since Rogers' Textbook of Pediatric Intensive Care (Fourth Edition) was published several years ago. The changing environment of extracorporeal support in terms of patient populations, technological advances, patient management, and outcome will be discussed. CONCLUSIONS Continued examination of the criteria and circumstances where extracorporeal life support is applied as well as outcomes which include morbidity, cost effectiveness, and quality of life are needed areas of continued research. Increasing collaborations between all centers performing extracorporeal life support throughout the world should remain a priority to further research and understanding of this complex field.
Collapse
|
18
|
Connelly JT, Weaver B, Seelhorst A, Beaty CD, McDonough M, Nicolson SC, Tabbutt S. Challenges at the Bedside With ECMO and VAD. World J Pediatr Congenit Heart Surg 2012; 3:67-71. [DOI: 10.1177/2150135111421794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients on circulatory support can be the source of multiple challenges including optimizing the circuit for specific congenital heart lesions, troubleshooting circuit failures, transporting patients on the circuit, anticoagulation and bleeding, transitioning to more mobile ventricular assist device, listing for thoracic organ transplantation, weaning from the circuit, and educating the patient and family about mechanical support. These challenges ideally require a specialized multidisciplinary team, which includes anesthesiologists, child life specialists, extracorporeal membrane oxygenation (ECMO) specialists, intensivists, nurses, nutritionists, perfusionists, pharmacists, respiratory therapists, social workers, and surgeons.
Collapse
Affiliation(s)
| | - Bonnie Weaver
- Penn State Hershey Children's Hospital, Hershey, PA, USA
| | | | | | | | | | - Sarah Tabbutt
- UCSF Medical Center, Pediatric Critical Care Medicine, Benioff Children’s Hospital, San Francisco, CA, USA
| |
Collapse
|
19
|
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]
|
20
|
Qiu F, Lu CK, Palanzo D, Baer LD, Myers JL, Ündar A. Hemodynamic Evaluation of the Avalon Elite Bi-Caval Dual Lumen Cannulae. Artif Organs 2011; 35:1048-51. [DOI: 10.1111/j.1525-1594.2011.01340.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|