title: Does an Open Recirculation Line Affect the Flow Rate and Pressure in a Neonatal Extracorporeal Life Support Circuit With a Centrifugal or Roller Pump?
abstract: The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 roller pump (RP group) or a RotaFlow centrifugal pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). Trials were conducted at flow rates ranging from 200 to 600 mL/min (200 mL/min increments) with a closed or open recirculation line at 36°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. In the RP group, the preoxygenator flow did not change when the recirculation line was open while the prearterial cannula flow decreased by 15.7-20.0% (P < 0.01). Circuit pressure, total circuit pressure drop, and hemodynamic energy delivered to patients also decreased (P < 0.01). In the CP group, the prearterial cannula flow did not change while preoxygenator flow increased by 13.6-18.8% (P < 0.01). Circuit pressure drop and hemodynamic energy transmission remained the same. The results showed that the shunt of an open recirculation line could decrease perfusion flow in patients in the ECLS circuit using a roller pump, but did not change perfusion flow in the circuit using a centrifugal pump. An additional flow sensor is needed to monitor perfusion flow in patients if any shunts exist in the ECLS circuit.
authors.affiliation: Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Shigang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Shannon B
authors.initials: SB
authors.lastname: Spencer
authors.affiliation: Department of Perfusion, Perfusion, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Woitas
authors.affiliation: Department of Neonatology, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Glass
authors.affiliation: Department of Public Health and Sciences, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Kunselman
authors.affiliation: 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.
authors.forename: Akif
authors.initials: A
authors.lastname: Ündar
mesh_terms: D001783:Blood Flow Velocity; D002498:Centrifugation / Q000295:instrumentation; D003198:Computer Simulation; D004867:Equipment Design; D004912:Erythrocytes / Q000166:cytology; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008021:Life Support Systems / Q000295:instrumentation; D008955:Models, Cardiovascular; D011312:Pressure
keywords: -Centrifugal pump; -Neonates; -Recirculation line; Extracorporeal life support