Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators

Khoshbin, Espeed; Westrope, Claire; Pooboni, Suneel; Machin, David; Killer, Hilliary; Peek, Giles J.; Sosnowski, Andrzej; Firmin, Richard K.

doi:10.1191/0267659105pf797oa

Cited by 42 publications

(38 citation statements)

References 26 publications

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“…It has been reported that hollow fiber membrane oxygenators have lower resistance to blood flow and induce significantly lower pressure drops compared with flat-sheet membrane and silicone membrane oxygenators, and thus, they are more suitable for pulsatile flow. 12,19,31 In addition, the structure and designs of hollow fiber membrane oxygenators have been found to have various impacts on pressure drops and quality of pulsatility as determined by EEP and SHE. 32 Also, a large part of hemodynamic energy has been reported to be absorbed by the arterial filter and arterial tubing.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Hemodynamic Energy at Different Vessels in an Adult Swine Model

Son

Ahn

Lee³

et al. 2010

ASAIO Journal

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Extra hemodynamic energy is one of the major benefits of pulsatile flow, improving blood flow to vital organs. But most (80%) of the hemodynamic energy generated from pulsatile flow is damped by the extracorporeal circuit. Most models devised to minimize hemodynamic energy loss have been in vitro pediatric models. The purpose of this study was to measure hemodynamic energy in different vessels of different organs with an in vivo adult swine model. An extracorporeal circuit was constructed for seven Yorkshire swine using a pulsatile pump (Twin-Pulse Life Support). The mean arterial pressure (MAP), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) at the renal artery, carotid artery, aortic cannula site, and postoxygenator site were measured simultaneously before starting the pump and at the pump rates of 25, 35, and 45 bpm. The MAP of the renal or carotid artery was 40.0%-51.2% of the postoxygenator site. The EEP and SHE of both arteries were 11.6%-13.0% and 5.5%-7.4% of the postoxygenator site, respectively. The MAP and EEP of both arteries after starting the pump were lower than at baseline. The SHE of the renal artery after starting the pump was significantly higher than at baseline. The SHE of the carotid artery increased substantially after starting the pump although not statistically significantly. There was a significant hemodynamic energy loss in both arterial sites compared with the postoxygenator site. Also, a difference in hemodynamic energy loss was observed in vessel-to-vessel or vessel-to-circuit site comparison. This difference creates a bias in studying pulsatility and its effects. Therefore, the measurement method of hemodynamic energy must be standardized and the measurement site clarified to yield accurate study results.

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Section: Discussionmentioning

confidence: 99%

Measurement of Hemodynamic Energy at Different Vessels in an Adult Swine Model

Son

Ahn

Lee³

et al. 2010

ASAIO Journal

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“…While the Medtronics 0800 (Medtronic Inc.) provides some benefits, like 100% gas exchange and high maximum flow rate (1.5 L/ min), its negative aspects, such as a higher preoxygenator pressure and pressure drop, higher resistance to blood flow, and depletion of pulsatility, impede ECLS circuit improvement. Hollow-fiber membrane oxygenators have adequate gas exchange, lower priming volumes, better preservation of coagulation proteins, low plasma leakage, and better hemodynamic characteristics (11,17). With pulsatile perfusion, this…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Types of Neonatal Extracorporeal Life Support Systems With Pulsatile and Nonpulsatile Flow

et al. 2009

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We compared the effects of two neonatal extracorporeal life support (ECLS) systems on circuit pressures and surplus hemodynamic energy levels in a simulated ECLS model. The clinical set-up included the Jostra HL-20 heart-lung machine, either the Medtronic ECMO (0800) or the MEDOS 800LT systems with company-provided circuit components, a 10 Fr arterial cannula, and a pseudo-patient. We tested the system in nonpulsatile and pulsatile flow modes at two flow rates using a 40/60 glycerin/water blood analog, for a total of 48 trials, with n = 6 for each set-up. The pressure drops over the Medtronic ECLS were significantly higher than those over the MEDOS system regardless of the flow rate or perfusion mode (144.8 +/- 0.2 mm Hg vs. 35.7 +/- 0.2 mm Hg, respectively, at 500 mL/min in nonpulsatile mode, P < 0.001). The preoxygenator mean arterial pressures were significantly increased and the precannula hemodynamic energy values were decreased with the Medtronic ECLS circuit. These results suggest that the MEDOS ECLS circuit better transmits hemodynamic energy to the patient, keeps mean circuit pressures lower, and has lower pressure drops than the Medtronic Circuit.

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“…Six MHF patches were affixed with polycin/vorite glue (60% Polycin, 40% Vorite by mass, Cas Chem) in a 50 mL conical tube. PMP MHFs were chosen due to an asymmetric geometry, which is attractive for its resistance to plasma weeping and would theoretically not experience increased plasma weeping if made hydrophilic by surface modification to support cell adhesion (Khoshbin et al, 2005;Lawson and Holt, 2007;Toomasian et al, 2005). Select groups of fiber patches were exposed to radio frequency glow discharge (RFGD; March Plasma Systems, Concord, CA) treatment while in the conical tube (0.3 Torr vacuum and ammonia gas for 60 s at 100 W).…”

Section: Surface Modification Of Mhfs To Support Endothelial Cell Growthmentioning

confidence: 99%

A biohybrid artificial lung prototype with active mixing of endothelialized microporous hollow fibers

Polk

Maul

McKeel

et al. 2010

Biotech & Bioengineering

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Acute respiratory distress syndrome (ARDS) affects nearly 150,000 patients per year in the US, and is associated with high mortality (≈40%) and suboptimal options for patient care. Mechanical ventilation and extracorporeal membrane oxygenation are limited to short-term use due to ventilator-induced lung injury and poor bio-compatibility, respectively. In this report, we describe the development of a biohybrid lung prototype, employing a rotating endothelialized microporous hollow fiber (MHF) bundle to improve blood biocompatibility while MHF mixing could contribute to gas transfer efficiency. MHFs were surface modified with radio frequency glow discharge (RFGD) and protein adsorption to promote endothelial cell (EC) attachment and growth. The MHF bundles were placed in the biohybrid lung prototype and rotated up to 1,500 revolutions per minute (rpm) using speed ramping protocols to condition ECs to remain adherent on the fibers. Oxygen transfer, thrombotic deposition, and EC p-selectin expression were evaluated as indicators of biohybrid lung functionality and biocompatibility. A fixed aliquot of blood in contact with MHF bundles rotated at either 250 or 750 rpm reached saturating pO2 levels more quickly with increased rpm, supporting the concept that fiber rotation would positively contribute to oxygen transfer. The presence of ECs had no effect on the rate of oxygen transfer at lower fiber rpm, but did provide some resistance with increased rpm when the overall rate of mass transfer was higher due to active mixing. RFGD followed by fibronectin adsorption on MHFs facilitated near confluent EC coverage with minimal p-selectin expression under both normoxic and hyperoxic conditions. Indeed, even subconfluent EC coverage on MHFs significantly reduced thrombotic deposition adding further support that endothelialization enhances, blood biocompatibility. Overall these findings demonstrate a proof-of-concept that a rotating endothelialized MHF bundle enhances gas transfer and biocompatibility, potentially producing safer, more efficient artificial lungs.

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Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators

Abstract: Small PMP oxygenators (Medos Hilite 800 LT) provide adequate gas exchange and offer technical advantages in terms of more efficient priming, reduced haemodynamic resistance and better control and preservation of coagulation proteins than silicone oxygenators.

Cited by 42 publications

References 26 publications

Measurement of Hemodynamic Energy at Different Vessels in an Adult Swine Model

Measurement of Hemodynamic Energy at Different Vessels in an Adult Swine Model

Comparison of Two Types of Neonatal Extracorporeal Life Support Systems With Pulsatile and Nonpulsatile Flow

A biohybrid artificial lung prototype with active mixing of endothelialized microporous hollow fibers

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