Pulsatile Versus Nonpulsatile Flow to Maintain the Equivalent Coronary Blood Flow in the Fibrillating Heart

Jung, Jae Seung; Son, Ho Sung; Lim, Choon Hak; Sun, Kyung

doi:10.1097/mat.0b013e31815b2d00

Cited by 15 publications

(13 citation statements)

References 33 publications

(37 reference statements)

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“…9 In previous studies from our group performed in similar experimental settings using T-PLS, pulsatile flow had a beneficial effect on organ perfusion when compared with nonpulsatile flow, especially in the kidney and coronary arteries. [2][3][4] Higher SHE may be a driving force in preserving microcirculation, therefore enabling organ preservation after extracorporeal circulation, although a large part of the hemodynamic energy seems to be lost in the circuit.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…Pulsatile flow has been reported to have beneficial effects on the microcirculation, metabolism, and organ function. [1][2][3][4] However, others have failed to observe any superiority of pulsatile flow over nonpulsatile flow. [5][6][7] The major cause of this controversy is the use of pulse pressure to quantify pulsatility.…”

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confidence: 93%

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

Son

Ahn

Lee³

et al. 2010

ASAIO Journal

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“…To the best of our knowledge, there is only one more pulsatile ECLS system available for adult patients. The Twin‐Pulse Life support (T‐PLS) system was developed at the Korea University in Seoul, Korea and evaluated through in vivo experiments . Investigators have clearly documented that T‐PLS system generated physiological pressure‐flow waveforms including adequate hemodynamic energy, EEP, and SHE levels in vivo .…”

Section: Discussionmentioning

confidence: 99%

Novel ECG-Synchronized Pulsatile ECLS System With Various Heart Rates and Cardiac Arrhythmias: An In Vitro Study

Wang

Spencer

Kunselman³

et al. 2017

Artificial Organs

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The objective of this study is to evaluate electrocardiography (ECG)-synchronized pulsatile flow under varying heart rates and different atrial and ventricular arrhythmias in a simulated extracorporeal life support (ECLS) system. The ECLS circuit consisted of an i-cor diagonal pump and console, an iLA membrane ventilator, and an 18 Fr arterial cannula. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). An ECG simulator was used to trigger pulsatile flow and to generate selected cardiac rhythms. All trials were conducted at a flow rate of 2.5 L/min at room temperature for normal sinus rhythm at 45-180 bpm under non-pulsatile and pulsatile modes. Various atrial and ventricular arrhythmias were also tested. Real-time pressure and flow data were recorded using a custom-based data acquisition system. The energy equivalent pressure (EEP) generated by pulsatile flow was always higher than the mean pressure. No surplus hemodynamic energy (SHE) was recorded under non-pulsatile mode. Under pulsatile mode, SHE levels increased with increasing heart rates (45-120 bpm). SHE levels under a 1:2 assist ratio were higher than the 1:1 and 1:3 assist ratios with a heart rate of 180 bpm. A similar trend was recorded for total hemodynamic energy levels. There was no statistical difference between the two perfusion modes with regards to pressure drops across the ECLS circuit. The main resistance and energy loss came from the arterial cannula. The i-cor console successfully tracked electrocardiographic signals of 12 atrial and ventricular arrhythmias. Our results demonstrated that the i-cor pulsatile ECLS system can be synchronized with a normal heart rate or with various atrial/ventricular arrhythmias. Further in vivo studies are warranted to confirm our findings.

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“…It has also been demonstrated that added pulsatility to continuous flow mechanical support improves organ perfusion in terms of blood flow, flow velocity in coronary artery [29,30], energy equivalent pressure and surplus hemodynamic energy, though not having influenced mean carotid pressure [31,32], and even improves a renal perfusion [33]. However, in most of these experiments, a central cannulation approach was used for both inflow and outflow cannulae.…”

Section: Discussionmentioning

confidence: 99%

Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation

et al. 2012

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IntroductionExtracorporeal membrane oxygenation (ECMO) is increasingly used in cardiac arrest (CA). Adequacy of carotid and coronary blood flows (CaBF, CoBF) and coronary perfusion pressure (CoPP) in ECMO treated CA is not well established. This study compares femoro-femoral (FF) to femoro-subclavian (FS) ECMO and intraaortic balloon counterpulsation (IABP) contribution based on CaBF, CoBF, CoPP, myocardial and brain oxygenation in experimental CA managed by ECMO.MethodsIn 11 female pigs (50.3 ± 3.4 kg), CA was randomly treated by FF versus FS ECMO ± IABP. Animals under general anesthesia had undergone 15 minutes of ventricular fibrillation (VF) with ECMO flow of 5 to 10 mL/kg/min simulating low-flow CA followed by continued VF with ECMO flow of 100 mL/kg/min. CaBF and CoBF were measured by a Doppler flow wire, cerebral and peripheral oxygenation by near infrared spectroscopy. CoPP, myocardial oxygen metabolism and resuscitability were determined.ResultsCaBF reached values > 80% of baseline in all regimens. CoBF > 80% was reached only by the FF ECMO, 90.0% (66.1, 98.6). Addition of IABP to FF ECMO decreased CoBF to 60.7% (55.1, 86.2) of baseline, P = 0.004. FS ECMO produced 70.0% (49.1, 113.2) of baseline CoBF, significantly lower than FF, P = 0.039. Addition of IABP to FS did not change the CoBF; however, it provided significantly higher flow, 76.7% (71.9, 111.2) of baseline, compared to FF + IABP, P = 0.026. Both brain and peripheral regional oxygen saturations decreased after induction of CA to 23% (15.0, 32.3) and 34% (23.5, 34.0), respectively, and normalized after ECMO institution. For brain saturations, all regimens reached values exceeding 80% of baseline, none of the comparisons between respective treatment approaches differed significantly. After a decline to 15 mmHg (9.5, 20.8) during CA, CoPP gradually rose with time to 68 mmHg (43.3, 84.0), P = 0 .003, with best recovery on FF ECMO. Resuscitability of the animals was high, both 5 and 60 minutes return of spontaneous circulation occured in eight animals (73%).ConclusionsIn a pig model of CA, both FF and FS ECMO assure adequate brain perfusion and oxygenation. FF ECMO offers better CoBF than FS ECMO. Addition of IABP to FF ECMO worsens CoBF. FF ECMO, more than FS ECMO, increases CoPP over time.

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Pulsatile Versus Nonpulsatile Flow to Maintain the Equivalent Coronary Blood Flow in the Fibrillating Heart

Cited by 15 publications

References 33 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

Novel ECG-Synchronized Pulsatile ECLS System With Various Heart Rates and Cardiac Arrhythmias: An In Vitro Study

Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation

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