Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul;47(7):1122-1132.
doi: 10.1111/aor.14523. Epub 2023 Apr 4.

A comprehensive evaluation of hemodynamic energy production and circuit loss using four different ECMO arterial cannulae

Silver Heinsar  1   2   3   4 , Nicole Bartnikowski  1 , Gunter Hartel  5 , Samia M Farah  1 , E-Peng Seah  1   6 , Eric Wu  1   2 , Sebastiano Maria Colombo  1   7   8 , Clayton Semenzin  1   8   9 , Andrew Haymet  1   2   3 , Indrek Rätsep  4 , Jo Pauls  6   9 , John F Fraser  1   2   3 , Jacky Y Suen  1   2
Affiliations

A comprehensive evaluation of hemodynamic energy production and circuit loss using four different ECMO arterial cannulae

Silver Heinsar et al. Artif Organs. 2023 Jul.

Abstract

Objective: Pulsatile-flow veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has shown encouraging results for microcirculation resuscitation and left ventricle unloading in patients with refractory cardiogenic shock. We aimed to comprehensively assess different V-A ECMO parameters and their contribution to hemodynamic energy production and transfer through the device circuit.

Methods: We used the i-cor® ECMO circuit, which composed of Deltastream DP3 diagonal pump and i-cor® console (Xenios AG), the Hilite 7000 membrane oxygenator (Xenios AG), venous and arterial tubing and a 1 L soft venous pseudo-patient reservoir. Four different arterial cannulae (Biomedicus 15 and 17 Fr, Maquet 15 and 17 Fr) were used. For each cannula, 192 different pulsatile modes were investigated by adjusting flow rate, systole/diastole ratio, pulsatile amplitudes and frequency, yielding 784 unique conditions. A dSpace data acquisition system was used to collect flow and pressure data.

Results: Increasing flow rates and pulsatile amplitudes were associated with significantly higher hemodynamic energy production (both p < 0.001), while no significant associations were seen while adjusting systole-to-diastole ratio (p = 0.73) or pulsing frequency (p = 0.99). Arterial cannula represents the highest resistance to hemodynamic energy transfer with 32%-59% of total hemodynamic energy generated being lost within, depending on pulsatile flow settings used.

Conclusions: Herein, we presented the first study to compare hemodynamic energy production with all pulsatile ECLS pump settings and their combinations and widely used yet previously unexamined four different arterial ECMO cannula. Only increased flow rate and amplitude increase hemodynamic energy production as single factors, whilst other factors are relevant when combined.

Keywords: cardiogenic shock; extracorporeal membrane oxygenation; mechanical circulatory support; mock circulation loop.

PubMed Disclaimer

References

REFERENCES

    1. Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circulation. Heart Failure. 2018;11:e004905.
    1. ECMO registry of the extracorporeal life support organization (ELSO). Ann Arbor, MI: ELSO; 2022.
    1. Mariscalco G, Salsano A, Fiore A, Dalén M, Ruggieri VG, Saeed D, et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg. 2020;160:1207-16.e44.
    1. Wang S, Kunselman AR, Clark JB, Ündar A. In vitro hemodynamic evaluation of a novel pulsatile extracorporeal life support system: impact of perfusion modes and circuit components on energy loss. Artif Organs. 2015;39:59-66.
    1. Jung JS, Son HS, Lim CH, Sun K. Pulsatile versus nonpulsatile flow to maintain the equivalent coronary blood flow in the fibrillating heart. ASAIO J. 2007;53:785-90.

LinkOut - more resources