title: Building a Better Neonatal Extracorporeal Life Support Circuit: Comparison of Hemodynamic Performance and Gaseous Microemboli Handling in Different Pump and Oxygenator Technologies.
abstract: Neurologic complications during neonatal extracorporeal life support (ECLS) are associated with significant morbidity and mortality. Gaseous microemboli (GME) in the ECLS circuit may be a possible cause. Advances in neonatal circuitry may improve hemodynamic performance and GME handling leading to reduction in patient complications. This study compared hemodynamic performance and GME handling using two centrifugal pumps (Maquet RotaFlow and Medos Deltastream DP3) and polymethylpentene oxygenators (Maquet Quadrox-iD and Medos Hilite 800LT) in a neonatal ECLS circuit model. The experimental circuit was primed with Lactated Ringer's solution and packed human red blood cells (hematocrit 40%) and arranged in parallel with the RotaFlow and DP3 pump, Quadrox-iD and Hilite oxygenator, and Better-Bladder. Hemodynamic trials evaluating pressure drops and total hemodynamic energy (THE) were conducted at 300 and 500 mL/min at 36°C. GME handling was measured after 0.5 mL of air was injected into the venous line using the Emboli Detection and Classification Quantifier System with unique pump, oxygenator, and Better-Bladder combinations. The RotaFlow pump and Quadrox oxygenator arrangement had lower pressure drops and THE loss at both flow rates compared to the DP3 pump and Hilite oxygenator (P < 0.01). Total GME volume and counts decreased with Better-Bladder at both flow rates with all combinations (P < 0.01). Hemodynamic performance and energy loss were similar in all of the circuit combinations. The Better-Bladder significantly decreased GME. All four combinations of pumps and oxygenators also performed similarly in terms of GME handling.
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.|Neonatal Intensive Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Glass
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.|Neonatal Intensive Care Unit, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Trivedi
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, 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 Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Woitas
authors.affiliation: Public Health and Sciences, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Kunselman
authors.affiliation: Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, PA, USA.|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: D004618:Embolism, Air / Q000517:prevention & control*; D004867:Equipment Design / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008955:Models, Cardiovascular; D009422:Nervous System Diseases / Q000517:prevention & control; D010107:Oxygenators, Membrane; D011312:Pressure
keywords: -Gaseous microemboli; -Hemodynamic performance; -Neonate; -Oxygenator; -Pump; Extracorporeal life support