1
|
Cornelisse Y, Weerwind PW, Bol ME, Simons AP. Assessment of cardiac load-responsiveness in veno-arterial extracorporeal life support: A case series. Perfusion 2023:2676591231181463. [PMID: 37279889 DOI: 10.1177/02676591231181463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Well-timed explant of veno-arterial extracorporeal life support (V-A ECLS) depends on adequate assessment of cardiac recovery. Often, evaluation of cardiac recovery consists of reducing support flow while visualizing cardiac response using transoesophageal echocardiography (TEE). This method, however, is time consuming and based on subjective findings. The dynamic filling index (DFI) may aid in the quantitative assessment of cardiac load-responsiveness. The dynamic filling index is based on the relationship of support flow and pump speed, which varies with varying hemodynamic conditions. This case series intends to investigate whether the DFI may support TEE in facilitating the assessment of cardiac load-responsiveness. METHODS Measurements for DFI-determination were performed in seven patients while simultaneously assessing ventricular function by measuring the aortic velocity time integral (VTI) using TEE. Measurements consisted of multiple consecutive transient speed manipulations (∼100 r/min) during weaning trials, both at full support and during cardiac reloading at reduced support. RESULTS The VTI increased between full and reduced support in six weaning trials. In five of these trials DFI decreased or remained equal, and in one case DFI increased. Of the three trials in which VTI decreased between full and reduced support, DFI increased in two cases and decreased in one case. Changes in DFI, however, are mostly smaller than the detection threshold of 0.4 mL/rotation. CONCLUSION Even though current level of accuracy of the parameter requires further investigation to increase reliability and possibly predictability, DFI seems likely to be a potential parameter in supporting TEE for the assessment of cardiac load-responsiveness.
Collapse
Affiliation(s)
- Y Cornelisse
- Department of Extra-Corporeal Circulation and Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - P W Weerwind
- Department of Extra-Corporeal Circulation and Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - M E Bol
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A P Simons
- Advanced Extracorporeal Therapies - perfusion services, training & education, Landgraaf, the Netherlands
| |
Collapse
|
2
|
Kusters RWJ, Simons AP, Lancé MD, Ganushchak YM, Bekers O, Weerwind PW. Blood warming, pump heating and haemolysis in low-flow extracorporeal life support; an in vitro study using freshly donated human blood. Perfusion 2016; 32:27-34. [DOI: 10.1177/0267659116656045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low-flow extracorporeal life support can be used for cardiopulmonary support of paediatric and neonatal patients and is also emerging as a therapy for patients suffering from exacerbation of chronic obstructive pulmonary disease. However, pump heating and haemolysis have proven to negatively affect the system and outcome. This in vitro study aimed at gaining insight into blood warming, pump heating and haemolysis related to the performance of a new low-flow centrifugal pump. Pump performance in the 400-1,500 ml/min flow range was modulated using small-sized dual-lumen catheters and freshly donated human blood. Measurements included plasma free haemoglobin, blood temperature, pump speed, pump pressure, blood flow and thermographic imaging. Blood warming (ΔTmax=0.5°C) had no relationship with pump performance or haemolysis (R2max=0.05). Pump performance-related parameters revealed no relevant relationships with haemolysis (R2max=0.36). Thermography showed no relevant heat zones in the pump (Tmax=36°C). Concerning blood warming, pump heating and haemolysis, we deem the centrifugal pump applicable for low-flow extracorporeal circulation.
Collapse
Affiliation(s)
- R W J Kusters
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - A P Simons
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - M D Lancé
- Department of Anesthesiology and Pain Treatment, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Y M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - O Bekers
- Department of Clinical Chemistry, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| |
Collapse
|
3
|
Simons AP, Martens EGHJ, Ganushchak YM, Weerwind PW. Centrifugal pump performance during low-flow extracorporeal CO2 removal; safety considerations. Perfusion 2014; 30:17-23. [PMID: 24919405 DOI: 10.1177/0267659114540024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to examine the hydrodynamic performance and gaseous microemboli (GME) activity of two centrifugal pumps for possible use in low-flow extracorporeal CO2 removal. MATERIALS & METHODS The performance of a Rotassist 2.8 and a Rotaflow 32 centrifugal pump (Maquet Cardiopulmonary AG, Hirrlingen, Germany) was evaluated in a water-glycerine mixture-filled in vitro circuit that enabled measurement of pressures and GME at the pump inlet and pump outlet. Pressure-flow curves were acquired in a 1,000 to 5,000 rpm range while increasing drainage resistance in one series and outlet resistance in another. RESULTS Respective minimum pump inlet and maximum pump outlet pressures were -539 mmHg and 754 mmHg for the Rotassist 2.8 and -606 mmHg and 806 mmHg for the Rotaflow 32. Maximum standard deviations on pump pressures and flow amounted to 3.0 mmHg and 0.03 L/min, respectively, regardless of pump type and drainage or outlet resistance. The GME at the pump outlet were detectable at pump inlet pressures below -156 mmHg at 0.2 L/min and 2,500 rpm for the Rotassist 2.8 and below -224 mmHg at 0.9 L/min and 3,000 rpm for the Rotaflow 32. CONCLUSION Both the Rotassist 2.8 and Rotaflow 32 centrifugal pumps show a comparably high hydrodynamic stability, but potential GME formation with decreasing pump inlet pressures should be taken into account to ensure safe centrifugal pump-based low-flow extracorporeal CO2 removal.
Collapse
Affiliation(s)
- A P Simons
- Deptartment of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - E G H J Martens
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Y M Ganushchak
- Deptartment of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - P W Weerwind
- Deptartment of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| |
Collapse
|
4
|
Simons AP. Commentary on: Efficacy and safety of strategies to preserve stable extracorporeal life support flow during hypovolemia. Perfusion 2013; 29:25. [PMID: 23985425 DOI: 10.1177/0267659113503095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Simons AP, Lindelauf AAMA, Ganushchak YM, Maessen JG, Weerwind PW. Efficacy and safety of strategies to preserve stable extracorporeal life support flow during simulated hypovolemia. Perfusion 2013; 29:18-24. [DOI: 10.1177/0267659113502833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: Without volume-buffering capacity in extracorporeal life support (ELS) systems, hypovolemia can acutely reduce support flow. This study aims at evaluating efficacy and safety of strategies for preserving stable ELS during hypovolemia. Material & Methods: Flow and/or pressure-guided servo pump control, a reserve-driven control strategy and a volume buffer capacity (VBC) device were evaluated with respect to pump flow, venous line pressure and arterial gaseous microemboli (GME) during simulated normovolemia and hypovolemia. Results: Normovolemia resulted in a GME-free pump flow of 3.1±0.0 L/min and a venous line pressure of −10±1 mmHg. Hypovolemia without servo pump control resulted in a GME-loaded flow of 2.3±0.4 L/min with a venous line pressure of −114±52 mmHg. Servo control resulted in an unstable and GME-loaded flow of 1.5±1.2 L/min. With and without servo pump control, the VBC device stabilised flow (SD = 0.2 and 0.0 L/min, respectively) and venous line pressure (SD=51 and 4 mmHg, respectively) with near-absent GME activity. Reserve-driven pump control combined with a VBC device restored a near GME-free flow of 2.7±0.0 L/min with a venous line pressure of −9±0 mmHg. Conclusion: In contrast to a reserve-driven pump control strategy combined with a VBC device, flow and pressure servo control for ELS show evident deficits in preserving stable and safe ELS flow during hypovolemia.
Collapse
Affiliation(s)
- AP Simons
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - AAMA Lindelauf
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - YM Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - JG Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - PW Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| |
Collapse
|
6
|
Simons AP, Donker DW, Weerwind PW. Re: Lindstrom et al. veno-right ventricular cannulation reduces recirculation in extracorporeal membrane oxygenation. Perfusion 2013; 28:368-9. [PMID: 23459793 DOI: 10.1177/0267659113480203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Abstract
Although a growing body of evidence indicates superiority of minimized cardiopulmonary bypass (mCPB) systems over conventional CPB systems, limited venous return can result in severe fluctuations of venous line pressure which can result in gaseous emboli. In this study, we investigated the influence of sub-atmospheric pressures and volume buffer capacity added to the venous line on the generation of gaseous emboli in the mCPB circuit. Two different mCPB systems (MEC - Maquet, n=7 and ECC.O - Sorin, n=8) and a conventional closed cardiopulmonary bypass (cCPB) system (n=12) were clinically evaluated. In the search for a way to increase volume buffer capacity of mCPB systems, we additionally evaluated the ‘Better Bladder’ (BB) in a mock circulation by simulating, repeatedly, decreased venous return while measuring pressure and gaseous embolic activity. Arterial gaseous emboli activity during clinical perfusion with a cCPB system was the lowest in comparison to the mCPB systems (312±465 versus 311±421 with MEC and 1,966±1,782 with ECC.O, counts per 10 minute time interval, respectively; p=0.03). The average volume per bubble in the arterial line was the highest in cases with cCPB (12.5±8.3 nL versus 8.0±4.2 nL with MEC and 4.6±4.8 nL with ECC.O; p=0.04 for both). Significant cross-correlation was obtained at various time offsets from 0 to +35 s between sub-atmospheric pressure in the venous line and gaseous emboli activity in both the venous and arterial lines. The in vitro data showed that incorporation of the BB dampens fluctuations of venous line pressure by approximately 30% and decreases gaseous emboli by up to 85%. In conclusion, fluctuations of sub-atmospheric venous line pressure during kinetic-assisted drainage are related to gaseous emboli. Volume buffer capacity added to the venous line can effectively dampen pressure fluctuations resulting from abrupt changes in venous return and, therefore, can help to increase the safety of minimized cardiopulmonary bypass by reducing gaseous microemboli formation resulting from degassing.
Collapse
Affiliation(s)
- YM Ganushchak
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht – CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - EE Ševerdija
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht – CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - AP Simons
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht – CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L van Garsse
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht – CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - PW Weerwind
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht – CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
8
|
Affiliation(s)
- AP Simons
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre - MUMC, Maastricht, the Netherlands,
| | - I. Groenenberg
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre - MUMC, Maastricht, the Netherlands
| | - YM Ganushchak
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre - MUMC, Maastricht, the Netherlands
| | - PW Weerwind
- Dept. of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre - MUMC, Maastricht, the Netherlands
| |
Collapse
|
9
|
Simons AP, Reesink KD, Lancé MD, van der Nagel T, van der Veen FH, Weerwind PW, Maessen JG. Reserve-driven flow control for extracorporeal life support: proof of principle. Perfusion 2010; 25:25-9. [DOI: 10.1177/0267659109360284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extracorporeal life support systems lack volume-buffering capacity. Therefore, any decrease in venous intravascular volume available for drainage may result in acutely reduced support flow. We recently developed a method to quantify drainable volume and now conceived a reserve-driven pump control strategy, which is different from existing pressure or flow servo control schemes. Here, we give an outline of the algorithm and present animal experimental data showing proof of principle. With an acute reduction in circulatory volume (10-15%), pump flow immediately dropped from 4.1 to 1.9 l/min. Our pump control algorithm was able to restore bypass flow to 3.2 l/min (about 80% of the original level) and, thereby, reduced the duration of the low-flow condition. This demonstrates that a reserve-driven pump control strategy, based on the continuous monitoring of drainable volume, may maintain extracorporeal circulatory support flow, despite serious changes in filling conditions.
Collapse
Affiliation(s)
| | - KD Reesink
- Dept. of Biomedical Engineering/Biophysics
| | - MD Lancé
- Dept. of Anaesthesiology and Pain Treatment/Dept. of Intensive Care Medicine, Cardiovascular Research Institute Maastricht — CARIM, Maastricht University Medical Centre — MUMC, Maastricht, the Netherlands
| | | | | | | | | |
Collapse
|
10
|
Kaminsky RK, Weber HJ, Simons AP, Kallweit S, Kramm K, Verdonck PR. Comparison of the flow downstream two prototypes of a new monoleaflet artificial aortic heart valve by means of PIV visualization. Comput Methods Biomech Biomed Engin 2005. [DOI: 10.1080/10255840512331388740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
11
|
Abstract
Stability of the lumbar spine is an important factor in determining spinal response to sudden loading. Using two different methods, this study evaluated how various trunk load magnitudes and directions affect lumbar spine stability. The first method was a quick release procedure in which effective trunk stiffness and stability were calculated from trunk kinematic response to a resisted-force release. The second method combined trunk muscle EMG data with a biomechanical model to calculate lumbar spine stability. Twelve subjects were tested in trunk flexion, extension, and lateral bending under nine permutations of vertical and horizontal trunk loading. The vertical load values were set at 0, 20, and 40% of the subject's body weight (BW). The horizontal loads were 0, 10, and 20% of BW. Effective spine stability as obtained from quick release experimentation increased significantly (p<0.01) with increased vertical and horizontal loading. It ranged from 785 (S.D.=580) Nm/rad under no-load conditions to 2200 (S.D.=1015) Nm/rad when the maximum horizontal and vertical loads were applied to the trunk simultaneously. Stability of the lumbar spine achieved prior to force release and estimated from the biomechanical model explained approximately 50% of variance in the effective spine stability obtained from quick release trials in extension and lateral bending (0.53<R(2)<0.63). There was no such correlation in flexion trials. It was concluded that lumbar spine stability increased with increased trunk load magnitude to the extent that this load brought about an increase in trunk muscle activation. Indirectly, our data suggest that muscle reflex response to sudden loading can augment the lumbar spine stability level achieved immediately prior to the sudden loading event.
Collapse
Affiliation(s)
- J Cholewicki
- Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, P.O. Box 208071, 06520-8071, New Haven, CT, USA.
| | | | | |
Collapse
|
12
|
Simons AP, Fisher RE. Time-related analysis of alachlor concentrations in Florida wells. Bull Environ Contam Toxicol 1997; 58:934-938. [PMID: 9136657 DOI: 10.1007/s001289900424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- A P Simons
- Florida DACS, 2600 Blairstone Road, Tallahassee, Florida 32399, USA
| | | |
Collapse
|
13
|
Abstract
Soil microorganisms colonizing soil water sampling devices (lysimeters) reduced concentrations of biodegradable organic chemicals, including 2,4-dichlorophenoxyacetic acid methyl ester, alachlor, methyl
m
-chlorobenzoate, and metolachlor as water entered through porous ceramic cups. In some cases, losses exceeded 99%. Additions of either a biocide (sodium hypochlorite) or a bacteriostat (copper salt) prevented microbial activity so that concentrations of test chemicals inside lysimeters equaled those outside. Field studies further indicated that treating lysimeters with a copper salt effectively prevented microbial activity. Thus, chemically treating soil water samplers could improve the accuracy of soil water data for a wide variety of analytes, including environmentally important organics, such as pesticides and industrial wastes, and inorganics, such as ammonia and nitrate.
Collapse
Affiliation(s)
- D L Lewis
- Environmental Research Laboratory and Technology Applications, Inc., U.S. Environmental Protection Agency, Athens, Georgia 30613; Institute of Ecology, University of Georgia, Athens, Georgia 30602 ; Scientific Evaluation Section, Bureau of Pesticides, Department of Agriculture and Consumer Services, State of Florida, Tallahassee, Florida 32311 ; and Pesticide & Review Section, Department of Environmental Regulation, State of Florida, Tallahassee, Florida 32399
| | | | | | | |
Collapse
|