title: In Vitro Evaluation of an Alternative Neonatal Extracorporeal Life Support Circuit on Hemodynamic Performance and Bubble Trap.
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.
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA.
authors.forename: Shannon B
authors.initials: SB
authors.lastname: Spencer
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA.
authors.forename: Shigang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Woitas
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Hershey, PA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Glass
authors.affiliation: Public Health and Sciences, Hershey, PA, USA.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Kunselman
authors.affiliation: 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.
authors.forename: Akif
authors.initials: A
authors.lastname: Ündar
mesh_terms: D001783:Blood Flow Velocity; D057505:Embolic Protection Devices; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008955:Models, Cardiovascular; D011312:Pressure
keywords: -Centrifugal pump; -Gaseous microemboli; -Hemodynamic energy; -Neonate; Extracorporeal life support