In Vivo Hemodynamic Performance Evaluation of Novel Electrocardiogram-Synchronized Pulsatile and Nonpulsatile Extracorporeal Life Support Systems in an Adult Swine Model

The primary objective of this study was to evaluate a novel electrocardiogram (ECG)‐synchronized pulsatile extracorporeal life support (ECLS) system for adult partial mechanical circulatory support for adequate quality of pulsatility and enhanced hemodynamic energy generation in an in vivo animal mo...

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Bibliographic Details
Published in:Artificial organs 2015-07, Vol.39 (7), p.E90-E101
Main Authors: Wang, Shigang, Izer, Jenelle M., Clark, Joseph B., Patel, Sunil, Pauliks, Linda, Kunselman, Allen R., Leach, Donald, Cooper, Timothy K., Wilson, Ronald P., Ündar, Akif
Format: Article
Language:English
Subjects:
Animals
Diagonal pump
ECG synchronization
Electrocardiography
Equipment Design
Extracorporeal life support
Extracorporeal Membrane Oxygenation - instrumentation
Female
Hemodynamics
Life Support Systems - instrumentation
Models, Animal
Polyenes - chemistry
Polymethylpentene membrane oxygenator
Pulsatile Flow
Swine
Swine extracorporeal life support mode
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Summary:The primary objective of this study was to evaluate a novel electrocardiogram (ECG)‐synchronized pulsatile extracorporeal life support (ECLS) system for adult partial mechanical circulatory support for adequate quality of pulsatility and enhanced hemodynamic energy generation in an in vivo animal model. The secondary aim was to assess end‐organ protection during nonpulsatile versus synchronized pulsatile flow mode. Ten adult swine were randomly divided into a nonpulsatile group (NP, n = 5) and pulsatile group (P, n = 5), and placed on ECLS for 24 h using an i‐cor system consisting of an i‐cor diagonal pump, an iLA membrane ventilator, an 18 Fr femoral arterial cannula and a 23/25 Fr femoral venous cannula. Trials were conducted at a flow rate of 2.5 L/min using nonpulsatile or pulsatile mode (with assist ratio 1:1). Real‐time pressure and flow data were recorded using a custom‐based data acquisition system. To the best of our knowledge, the oxygenator and circuit pressure drops were the lowest for any available system in both groups. The ECG‐synchronized i‐cor ECLS system was able to trigger pulsatile flow in the porcine model. After 24‐h ECLS, energy equivalent pressure, surplus hemodynamic energy, and total hemodynamic energy at preoxygenator and prearterial cannula sites were significantly higher in the P group than those in the NP group (P  0.05). The novel i‐cor system performed well in the nonpulsatile and ECG‐synchronized pulsatile mode in an adult animal ECLS model. The iLA membrane oxygenator had an extremely lower transmembrane pressure gradient and excellent gas exchange capability. Our findings suggest that ECG‐triggered pulsatile ECLS provides superior end‐organ protection with improved renal function and systemic vascular tone.
ISSN:0160-564X
1525-1594
DOI:10.1111/aor.12482