Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems.
The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12 h at a flow rate of 500 mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean ± standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6 ± 253.1 mg/L, DP3-NP group: 343.7 ± 163.2 mg/L, and DP3-P group: 407.6 ± 156.6 mg/L, P = 0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P > 0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P < 0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.
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.
Shigang
S
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.|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.
Conrad
C
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 Cardiology, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Sunil
S
Patel
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.
Allen R
AR
Kunselman
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.
Jianxun
J
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
F
Lei
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.
Larry D
LD
Baer
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.
Akif
A
Ündar
D016207:Cytokines / Q000097:blood; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation*; D006439:Hemodynamics; D006461:Hemolysis; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D008021:Life Support Systems / Q000295:instrumentation*; D011673:Pulsatile Flow
D016207:Cytokines
Diagonal pump; Extracorporeal life support; Hemolysis; Neonates; Nonpulsatile flow; Pulsatile flow; Roller pump; Systemic inflammatory response