title: Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure.
abstract: The objective of this study was to compare the effects of pulsatile and nonpulsatile extracorporeal membrane oxygenation (ECMO) on hemodynamic energy and systemic microcirculation in an acute cardiac failure model in piglets. Fourteen piglets with a mean body weight of 6.08 ± 0.86 kg were divided into pulsatile (N = 7) and nonpulsatile (N = 7) ECMO groups. The experimental ECMO circuit consisted of a centrifugal pump, a membrane oxygenator, and a pneumatic pulsatile flow generator system developed in-house. Nonpulsatile ECMO was initiated at a flow rate of 140 mL/kg/min for the first 30 min with normal heart beating, with rectal temperature maintained at 36°C. Ventricular fibrillation was then induced with a 3.5-V alternating current to generate a cardiac dysfunction model. Using this model, we collected the data on pulsatile and nonpulsatile groups. The piglets were weaned off ECMO at the end of the experiment (180 min after ECMO was initiated). The animals did not receive blood transfusions, inotropic drugs, or vasoactive drugs. Blood samples were collected to measure hemoglobin, methemoglobin, blood gases, electrolytes, and lactic acid levels. Hemodynamic energy was calculated using the Shepard's energy equivalent pressure. Near-infrared spectroscopy was used to monitor brain and kidney perfusion. The pulsatile ECMO group had a higher atrial pressure (systolic and mean), and significantly higher regional saturation at the brain level, than the nonpulsatile group (for both, P < 0.05). Additionally, the pulsatile ECMO group had higher methemoglobin levels within the normal range than the nonpulsatile group. Our study demonstrated that pulsatile ECMO produces significantly higher hemodynamic energy and improves systemic microcirculation, compared with nonpulsatile ECMO in acute cardiac failure.
authors.affiliation: Department of Medical Engineering, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan.|Departments of, Emergency and Critical Care Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hideshi
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Community and Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Ichiba
authors.affiliation: Departments of, Emergency and Critical Care Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ujike
authors.affiliation: Department of, Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Douguchi
authors.affiliation: Biomedical Engineering, Okayama University of Science, Okayama, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Obata
authors.affiliation: Department of Medical Engineering, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan.
authors.forename: Syuji
authors.initials: S
authors.lastname: Inamori
authors.affiliation: Anesthesiology, Okayama University Hospital, Okayama, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Iwasaki
authors.affiliation: Department of, Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kasahara
authors.affiliation: Department of, Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
authors.affiliation: Departments of Pediatrics, Surgery, and Bioengineering, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA.
authors.forename: Akif
authors.initials: A
authors.lastname: Ündar
mesh_terms: D000208:Acute Disease; D000818:Animals; D000831:Animals, Newborn; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D008833:Microcirculation; D010107:Oxygenators, Membrane; D010477:Perfusion / Q000295:instrumentation; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D012079:Renal Circulation; D019265:Spectroscopy, Near-Infrared; D013552:Swine; D013997:Time Factors
keywords: Extracorporeal membrane oxygenation; Hemodynamic energy; Pediatric; Pulsatile; Systemic microcirculation