The Experts below are selected from a list of 2724 Experts worldwide ranked by ideXlab platform

Akif Ündar - One of the best experts on this subject based on the ideXlab platform.

  • in vitro evaluation of capiox fx05 and rx05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum assisted venous drainage levels
    Artificial Organs, 2020
    Co-Authors: Shyama Sathianathan, Shigang Wang, Allen R Kunselman, Rafay Nasir, Akif Ündar
    Abstract:

    The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different vacuum-assisted venous drainage (VAVD) vacuum levels and venous reservoir levels in a neonatal cardiopulmonary bypass circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 Arterial filter to Capiox FX05 oxygenator with integrated Arterial filter. Arterial Cannula flow rate to the patient was held at 500 mL/min and temperature maintained at 32°C, while VAVD vacuum levels (0 mm Hg, -15 mm Hg, -30 mm Hg, -45 mm Hg, -60 mm Hg) and venous reservoir levels (50 mL, 200 mL) were evaluated in both oxygenators. Hemodynamic parameters measuring flow, pressure, and total hemodynamic energy were made in real time using a custom-made data acquisition system and Labview software. Nearly 10 cc bolus of air was injected into the venous line and gaseous microemboli detected using an Emboli Detection and Classification Quantifier. Diverted blood flow via the Arterial filter's purge line and mean pressures increased with increasing VAVD levels (P < 0.01). Mean pressures were lower with lower venous reservoir levels and were greater in RX05 groups compared to FX05 (P < 0.01). Microemboli detected at the preoxygenator site increased with higher VAVD vacuum levels and lower venous reservoir levels (P < 0.01). The amount of microemboli captured by the FX05 oxygenator with integrated Arterial filter was greater than by the RX05 oxygenator alone, although both oxygenators were able to clear microemboli before reaching the pseudo-patient.

  • evaluation of two femoral Arterial Cannulae with conventional non pulsatile and alternative pulsatile flow in a simulated adult ecls circuit
    Artificial Organs, 2019
    Co-Authors: Madison Force, Christoph Brehm, Akif Ündar
    Abstract:

    The objective of this study is to evaluate the hemodynamic characteristics of two femoral Arterial Cannulae in terms of circuit pressure, pressure drop, and hemodynamic energy transmission under non-pulsatile and pulsatile modes in a simulated adult extracorporeal life support (ECLS) system. The ECLS circuit consisted of i-cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr or 16 Fr femoral Arterial Cannula (Xenios AG), and a 23/25 Fr Estech remote access perfusion (RAP) femoral venous Cannula (San Ramon, CA, USA). The circuit was primed with lactated Ringer's solution and packed red blood cells to achieve a hematocrit of 35%. All trials were conducted at room temperature with flow rates of 1-4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 bpm and pulsatile amplitudes of 1000-4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom data acquisition system. Total hemodynamic energy (THE) is calculated by multiplying the ratio between the area under the hemodynamic power curve (∫flow × pressure dt) and the area under the pump flow curve (∫flow dt) by 1332. The pressure drop across the Arterial Cannula increased with increasing flow rate and decreasing Cannula size. The pressure drops of 18 Fr and 16 Fr Cannulae were 19.4-24.5 and 38.4-45.3 mm Hg at 1 L/min, 55.2-56.8 and 110.9-118.3 mm Hg at 2 L/min, 94.1-105.1 and 209.7-215.1 mm Hg at 3 L/min, and 169.2-172.6 and 376.4 mm Hg at 4 L/min, respectively. Pulsatile flow created more hemodynamic energy than non-pulsatile flow, especially at lower flow rates. The percentages of THE loss across 18 Fr and 16 Fr Cannula were 16.0-18.7 and 27.5-30.8% at 1 L/min, 35.1-35.7 and 52.3-53.8% at 2 L/min, 48.3-50.3 and 67.3-68.4% at 3 L/min and 62.9-63.1 and 79.0% at 4 L/min. The hemodynamic performance of the Arterial Cannula should be evaluated before use in clinical practice. The pressure drops and percentages of THE loss across two Cannulae tested using human blood were higher compared to the manufacturer's data tested using water. The Cannula size should be chosen to match the expected flow rate. In addition, this novel i-cor ECLS system can provide non-pulsatile and ECG-synchronized pulsatile flow without significantly increasing the Cannula pressure drop and hemodynamic energy loss.

  • in vitro evaluation of pediatric hollow fiber membrane oxygenators on hemodynamic performance and gaseous microemboli handling an international multicenter multidisciplinary approach
    Artificial Organs, 2017
    Co-Authors: Shigang Wang, Allen R Kunselman, Luiz Fernando Caneo, Fabio Biscegli Jatene, Marcelo B Jatene, Idagene A Cestari, Akif Ündar
    Abstract:

    The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an Arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated Arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr Arterial Cannula, primed with lactated Ringer's solution and packed red blood cells. Trials were conducted at flow rates ranging from 500 to 2000 mL/min (500 mL/min increment) at 35°C and 28°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For GME testing, 5 cc of air was manually injected into the venous line. GME were recorded using the Emboli Detection and Classification Quantifier (EDAC) System. An additional experiment using a separate Arterial filter was conducted. There was no difference in the mean circuit pressure, pressure drop, total hemodynamic energy level, and energy loss between the two oxygenators. The venous line pressures were higher in the Braile than in the Quadrox group during all trials (P <0.01). GME count and volume at pre-/post oxygenator and pre-Cannula sites in the Quadrox were lower than the Braile group at high flow rates (P < 0.05). In the additional experiment, an Arterial filter captured a significant number of microemboli at all flow rates. The Braile Infant oxygenator has a matched hemodynamic characteristic with the Quadrox-i Pediatric oxygenator. The Quadrox-i has a better GME handling ability compared with the Braile Infant oxygenator. Regardless of type of oxygenator an additional Arterial filter decreases the number of GME.

  • in vitro hemodynamic evaluation of five 6 fr and 8 fr Arterial Cannulae in simulated neonatal cardiopulmonary bypass circuits
    Artificial Organs, 2016
    Co-Authors: Shigang Wang, Akif Ündar, David Palanzo, Allen R Kunselman
    Abstract:

    The objective of this study was to evaluate five small-bore Arterial Cannulae (6Fr and 8Fr) in terms of pressure drop and hemodynamic performance in simulated neonatal cardiopulmonary bypass (CPB) circuits. The experimental circuits consisted of a Jostra HL-20 roller pump, a Terumo Capiox Baby FX05 oxygenator with integrated Arterial filter, an Arterial and a venous tubing (1/4, 3/16, or 1/8 in × 150 cm), and an Arterial Cannula (Medtronic Bio-Medicus 6Fr and 8Fr, Maquet 6Fr and 8Fr, or RMI Edwards 8Fr). The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates (6Fr: 200-400 mL/min; 8Fr: 200-600 mL/min) and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Higher circuit pressure, circuit pressure drop, and hemodynamic energy loss across the circuit were recorded when using small-bore Arterial Cannula and small inner diameter Arterial tubing in a neonatal CPB circuit. The maximum preoxygenator pressures reached 449.7 ± 1.0 mm Hg (Maquet 6Fr at 400 mL/min), and 395.7 ± 0.4 mm Hg (DLP 8Fr at 600 mL/min) when using 1/8 in ID Arterial tubing at 28°C. Hypothermia further increased circuit pressure drop and hemodynamic energy loss. Compared with the others, the RMI 8Fr Arterial Cannula had significantly lower pressure drop and energy loss. Maquet 6Fr Arterial Cannula had a greater pressure drop than the DLP 6Fr. A small-bore Arterial Cannula and Arterial tubing created high circuit pressure drop and hemodynamic energy loss. Appropriate Arterial Cannula and Arterial tubing should be considered to match the expected flow rate. Larger Cannula and tubing are recommended for neonatal CPB. Low-resistance neonatal Arterial Cannulae need to be developed.

  • impact of pulsatility and flow rates on hemodynamic energy transmission in an adult extracorporeal life support system
    Artificial Organs, 2015
    Co-Authors: Rachel Wolfe, Akif Ündar, Allen R Kunselman, Shigang Wang, Ashton Strother
    Abstract:

    This study investigated the total hemodynamic energy (THE) and surplus hemodynamic energy transmis- sion (SHE) of a novel adult extracorporeal life support (ECLS) system with nonpulsatile and pulsatile settings and varying pulsatility to define the most effective setting for this circuit. The circuit consisted of an i-cor diagonal pump (Xenios AG, Heilbronn, Germany), an XLung mem- brane oxygenator (Xenios AG), an 18 Fr Medos femoral Arterial Cannula (Xenios AG), a 23/25 Fr Estech RAP femoral venous Cannula (San Ramon, CA, USA), 3/8 in ID × 140 cm Arterial tubing, and 3/8 in ID × 160 cm venous tubing. Priming was done with lactated Ringer's solution and packed red blood cells (HCT 36%). The trials were conducted at flow rates 1-4 L/min (1 L/min increments) under nonpulsatile and pulsatile mode, with differential speed values 1000-4000 rpm (1000 rpm increments) at 36°. The pseudo patient's mean Arterial pressure was kept at 100 mm Hg using a Hoffman clamp during all trials. Real- time flow and pressure data were collected using a custom- based data acquisition system. Mean pressures across the circuit increased with increasing flow rates, but increased insignificantly with increasing differential speed values. Mean pressure did not change significantly between pulsa- tile and nonpulsatile modes. Pulsatile flow created more THE than nonpulsatile flow at the preoxygenator site (P < 0.01). Of the different components of the circuit, the Arterial Cannula created the greatest THE loss. THE loss across the circuit ranged from 24.8 to 71.3%. Still, under pulsatile mode, more THE was delivered to the pseudo patient at low flow rates. No SHE was created with nonpulsatile flow, but SHE was created with pulsatile flow, and increased with increasing differential speed values. At

Shigang Wang - One of the best experts on this subject based on the ideXlab platform.

  • in vitro evaluation of capiox fx05 and rx05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum assisted venous drainage levels
    Artificial Organs, 2020
    Co-Authors: Shyama Sathianathan, Shigang Wang, Allen R Kunselman, Rafay Nasir, Akif Ündar
    Abstract:

    The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different vacuum-assisted venous drainage (VAVD) vacuum levels and venous reservoir levels in a neonatal cardiopulmonary bypass circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 Arterial filter to Capiox FX05 oxygenator with integrated Arterial filter. Arterial Cannula flow rate to the patient was held at 500 mL/min and temperature maintained at 32°C, while VAVD vacuum levels (0 mm Hg, -15 mm Hg, -30 mm Hg, -45 mm Hg, -60 mm Hg) and venous reservoir levels (50 mL, 200 mL) were evaluated in both oxygenators. Hemodynamic parameters measuring flow, pressure, and total hemodynamic energy were made in real time using a custom-made data acquisition system and Labview software. Nearly 10 cc bolus of air was injected into the venous line and gaseous microemboli detected using an Emboli Detection and Classification Quantifier. Diverted blood flow via the Arterial filter's purge line and mean pressures increased with increasing VAVD levels (P < 0.01). Mean pressures were lower with lower venous reservoir levels and were greater in RX05 groups compared to FX05 (P < 0.01). Microemboli detected at the preoxygenator site increased with higher VAVD vacuum levels and lower venous reservoir levels (P < 0.01). The amount of microemboli captured by the FX05 oxygenator with integrated Arterial filter was greater than by the RX05 oxygenator alone, although both oxygenators were able to clear microemboli before reaching the pseudo-patient.

  • in vitro evaluation of pediatric hollow fiber membrane oxygenators on hemodynamic performance and gaseous microemboli handling an international multicenter multidisciplinary approach
    Artificial Organs, 2017
    Co-Authors: Shigang Wang, Allen R Kunselman, Luiz Fernando Caneo, Fabio Biscegli Jatene, Marcelo B Jatene, Idagene A Cestari, Akif Ündar
    Abstract:

    The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an Arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated Arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr Arterial Cannula, primed with lactated Ringer's solution and packed red blood cells. Trials were conducted at flow rates ranging from 500 to 2000 mL/min (500 mL/min increment) at 35°C and 28°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For GME testing, 5 cc of air was manually injected into the venous line. GME were recorded using the Emboli Detection and Classification Quantifier (EDAC) System. An additional experiment using a separate Arterial filter was conducted. There was no difference in the mean circuit pressure, pressure drop, total hemodynamic energy level, and energy loss between the two oxygenators. The venous line pressures were higher in the Braile than in the Quadrox group during all trials (P <0.01). GME count and volume at pre-/post oxygenator and pre-Cannula sites in the Quadrox were lower than the Braile group at high flow rates (P < 0.05). In the additional experiment, an Arterial filter captured a significant number of microemboli at all flow rates. The Braile Infant oxygenator has a matched hemodynamic characteristic with the Quadrox-i Pediatric oxygenator. The Quadrox-i has a better GME handling ability compared with the Braile Infant oxygenator. Regardless of type of oxygenator an additional Arterial filter decreases the number of GME.

  • in vitro hemodynamic evaluation of five 6 fr and 8 fr Arterial Cannulae in simulated neonatal cardiopulmonary bypass circuits
    Artificial Organs, 2016
    Co-Authors: Shigang Wang, Akif Ündar, David Palanzo, Allen R Kunselman
    Abstract:

    The objective of this study was to evaluate five small-bore Arterial Cannulae (6Fr and 8Fr) in terms of pressure drop and hemodynamic performance in simulated neonatal cardiopulmonary bypass (CPB) circuits. The experimental circuits consisted of a Jostra HL-20 roller pump, a Terumo Capiox Baby FX05 oxygenator with integrated Arterial filter, an Arterial and a venous tubing (1/4, 3/16, or 1/8 in × 150 cm), and an Arterial Cannula (Medtronic Bio-Medicus 6Fr and 8Fr, Maquet 6Fr and 8Fr, or RMI Edwards 8Fr). The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates (6Fr: 200-400 mL/min; 8Fr: 200-600 mL/min) and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Higher circuit pressure, circuit pressure drop, and hemodynamic energy loss across the circuit were recorded when using small-bore Arterial Cannula and small inner diameter Arterial tubing in a neonatal CPB circuit. The maximum preoxygenator pressures reached 449.7 ± 1.0 mm Hg (Maquet 6Fr at 400 mL/min), and 395.7 ± 0.4 mm Hg (DLP 8Fr at 600 mL/min) when using 1/8 in ID Arterial tubing at 28°C. Hypothermia further increased circuit pressure drop and hemodynamic energy loss. Compared with the others, the RMI 8Fr Arterial Cannula had significantly lower pressure drop and energy loss. Maquet 6Fr Arterial Cannula had a greater pressure drop than the DLP 6Fr. A small-bore Arterial Cannula and Arterial tubing created high circuit pressure drop and hemodynamic energy loss. Appropriate Arterial Cannula and Arterial tubing should be considered to match the expected flow rate. Larger Cannula and tubing are recommended for neonatal CPB. Low-resistance neonatal Arterial Cannulae need to be developed.

  • impact of pulsatility and flow rates on hemodynamic energy transmission in an adult extracorporeal life support system
    Artificial Organs, 2015
    Co-Authors: Rachel Wolfe, Akif Ündar, Allen R Kunselman, Shigang Wang, Ashton Strother
    Abstract:

    This study investigated the total hemodynamic energy (THE) and surplus hemodynamic energy transmis- sion (SHE) of a novel adult extracorporeal life support (ECLS) system with nonpulsatile and pulsatile settings and varying pulsatility to define the most effective setting for this circuit. The circuit consisted of an i-cor diagonal pump (Xenios AG, Heilbronn, Germany), an XLung mem- brane oxygenator (Xenios AG), an 18 Fr Medos femoral Arterial Cannula (Xenios AG), a 23/25 Fr Estech RAP femoral venous Cannula (San Ramon, CA, USA), 3/8 in ID × 140 cm Arterial tubing, and 3/8 in ID × 160 cm venous tubing. Priming was done with lactated Ringer's solution and packed red blood cells (HCT 36%). The trials were conducted at flow rates 1-4 L/min (1 L/min increments) under nonpulsatile and pulsatile mode, with differential speed values 1000-4000 rpm (1000 rpm increments) at 36°. The pseudo patient's mean Arterial pressure was kept at 100 mm Hg using a Hoffman clamp during all trials. Real- time flow and pressure data were collected using a custom- based data acquisition system. Mean pressures across the circuit increased with increasing flow rates, but increased insignificantly with increasing differential speed values. Mean pressure did not change significantly between pulsa- tile and nonpulsatile modes. Pulsatile flow created more THE than nonpulsatile flow at the preoxygenator site (P < 0.01). Of the different components of the circuit, the Arterial Cannula created the greatest THE loss. THE loss across the circuit ranged from 24.8 to 71.3%. Still, under pulsatile mode, more THE was delivered to the pseudo patient at low flow rates. No SHE was created with nonpulsatile flow, but SHE was created with pulsatile flow, and increased with increasing differential speed values. At

  • in vivo hemodynamic performance evaluation of novel electrocardiogram synchronized pulsatile and nonpulsatile extracorporeal life support systems in an adult swine model
    Artificial Organs, 2015
    Co-Authors: Shigang Wang, Allen R Kunselman, Joseph B Clark, Jenelle M Izer, Sunil Patel, Linda B Pauliks, Donald Leach, Timothy K Cooper, Ronald P Wilson, Akif Ündar
    Abstract:

    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.

Allen R Kunselman - One of the best experts on this subject based on the ideXlab platform.

  • in vitro evaluation of capiox fx05 and rx05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum assisted venous drainage levels
    Artificial Organs, 2020
    Co-Authors: Shyama Sathianathan, Shigang Wang, Allen R Kunselman, Rafay Nasir, Akif Ündar
    Abstract:

    The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different vacuum-assisted venous drainage (VAVD) vacuum levels and venous reservoir levels in a neonatal cardiopulmonary bypass circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 Arterial filter to Capiox FX05 oxygenator with integrated Arterial filter. Arterial Cannula flow rate to the patient was held at 500 mL/min and temperature maintained at 32°C, while VAVD vacuum levels (0 mm Hg, -15 mm Hg, -30 mm Hg, -45 mm Hg, -60 mm Hg) and venous reservoir levels (50 mL, 200 mL) were evaluated in both oxygenators. Hemodynamic parameters measuring flow, pressure, and total hemodynamic energy were made in real time using a custom-made data acquisition system and Labview software. Nearly 10 cc bolus of air was injected into the venous line and gaseous microemboli detected using an Emboli Detection and Classification Quantifier. Diverted blood flow via the Arterial filter's purge line and mean pressures increased with increasing VAVD levels (P < 0.01). Mean pressures were lower with lower venous reservoir levels and were greater in RX05 groups compared to FX05 (P < 0.01). Microemboli detected at the preoxygenator site increased with higher VAVD vacuum levels and lower venous reservoir levels (P < 0.01). The amount of microemboli captured by the FX05 oxygenator with integrated Arterial filter was greater than by the RX05 oxygenator alone, although both oxygenators were able to clear microemboli before reaching the pseudo-patient.

  • in vitro evaluation of pediatric hollow fiber membrane oxygenators on hemodynamic performance and gaseous microemboli handling an international multicenter multidisciplinary approach
    Artificial Organs, 2017
    Co-Authors: Shigang Wang, Allen R Kunselman, Luiz Fernando Caneo, Fabio Biscegli Jatene, Marcelo B Jatene, Idagene A Cestari, Akif Ündar
    Abstract:

    The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an Arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated Arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr Arterial Cannula, primed with lactated Ringer's solution and packed red blood cells. Trials were conducted at flow rates ranging from 500 to 2000 mL/min (500 mL/min increment) at 35°C and 28°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For GME testing, 5 cc of air was manually injected into the venous line. GME were recorded using the Emboli Detection and Classification Quantifier (EDAC) System. An additional experiment using a separate Arterial filter was conducted. There was no difference in the mean circuit pressure, pressure drop, total hemodynamic energy level, and energy loss between the two oxygenators. The venous line pressures were higher in the Braile than in the Quadrox group during all trials (P <0.01). GME count and volume at pre-/post oxygenator and pre-Cannula sites in the Quadrox were lower than the Braile group at high flow rates (P < 0.05). In the additional experiment, an Arterial filter captured a significant number of microemboli at all flow rates. The Braile Infant oxygenator has a matched hemodynamic characteristic with the Quadrox-i Pediatric oxygenator. The Quadrox-i has a better GME handling ability compared with the Braile Infant oxygenator. Regardless of type of oxygenator an additional Arterial filter decreases the number of GME.

  • in vitro hemodynamic evaluation of five 6 fr and 8 fr Arterial Cannulae in simulated neonatal cardiopulmonary bypass circuits
    Artificial Organs, 2016
    Co-Authors: Shigang Wang, Akif Ündar, David Palanzo, Allen R Kunselman
    Abstract:

    The objective of this study was to evaluate five small-bore Arterial Cannulae (6Fr and 8Fr) in terms of pressure drop and hemodynamic performance in simulated neonatal cardiopulmonary bypass (CPB) circuits. The experimental circuits consisted of a Jostra HL-20 roller pump, a Terumo Capiox Baby FX05 oxygenator with integrated Arterial filter, an Arterial and a venous tubing (1/4, 3/16, or 1/8 in × 150 cm), and an Arterial Cannula (Medtronic Bio-Medicus 6Fr and 8Fr, Maquet 6Fr and 8Fr, or RMI Edwards 8Fr). The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates (6Fr: 200-400 mL/min; 8Fr: 200-600 mL/min) and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Higher circuit pressure, circuit pressure drop, and hemodynamic energy loss across the circuit were recorded when using small-bore Arterial Cannula and small inner diameter Arterial tubing in a neonatal CPB circuit. The maximum preoxygenator pressures reached 449.7 ± 1.0 mm Hg (Maquet 6Fr at 400 mL/min), and 395.7 ± 0.4 mm Hg (DLP 8Fr at 600 mL/min) when using 1/8 in ID Arterial tubing at 28°C. Hypothermia further increased circuit pressure drop and hemodynamic energy loss. Compared with the others, the RMI 8Fr Arterial Cannula had significantly lower pressure drop and energy loss. Maquet 6Fr Arterial Cannula had a greater pressure drop than the DLP 6Fr. A small-bore Arterial Cannula and Arterial tubing created high circuit pressure drop and hemodynamic energy loss. Appropriate Arterial Cannula and Arterial tubing should be considered to match the expected flow rate. Larger Cannula and tubing are recommended for neonatal CPB. Low-resistance neonatal Arterial Cannulae need to be developed.

  • impact of pulsatility and flow rates on hemodynamic energy transmission in an adult extracorporeal life support system
    Artificial Organs, 2015
    Co-Authors: Rachel Wolfe, Akif Ündar, Allen R Kunselman, Shigang Wang, Ashton Strother
    Abstract:

    This study investigated the total hemodynamic energy (THE) and surplus hemodynamic energy transmis- sion (SHE) of a novel adult extracorporeal life support (ECLS) system with nonpulsatile and pulsatile settings and varying pulsatility to define the most effective setting for this circuit. The circuit consisted of an i-cor diagonal pump (Xenios AG, Heilbronn, Germany), an XLung mem- brane oxygenator (Xenios AG), an 18 Fr Medos femoral Arterial Cannula (Xenios AG), a 23/25 Fr Estech RAP femoral venous Cannula (San Ramon, CA, USA), 3/8 in ID × 140 cm Arterial tubing, and 3/8 in ID × 160 cm venous tubing. Priming was done with lactated Ringer's solution and packed red blood cells (HCT 36%). The trials were conducted at flow rates 1-4 L/min (1 L/min increments) under nonpulsatile and pulsatile mode, with differential speed values 1000-4000 rpm (1000 rpm increments) at 36°. The pseudo patient's mean Arterial pressure was kept at 100 mm Hg using a Hoffman clamp during all trials. Real- time flow and pressure data were collected using a custom- based data acquisition system. Mean pressures across the circuit increased with increasing flow rates, but increased insignificantly with increasing differential speed values. Mean pressure did not change significantly between pulsa- tile and nonpulsatile modes. Pulsatile flow created more THE than nonpulsatile flow at the preoxygenator site (P < 0.01). Of the different components of the circuit, the Arterial Cannula created the greatest THE loss. THE loss across the circuit ranged from 24.8 to 71.3%. Still, under pulsatile mode, more THE was delivered to the pseudo patient at low flow rates. No SHE was created with nonpulsatile flow, but SHE was created with pulsatile flow, and increased with increasing differential speed values. At

  • in vivo hemodynamic performance evaluation of novel electrocardiogram synchronized pulsatile and nonpulsatile extracorporeal life support systems in an adult swine model
    Artificial Organs, 2015
    Co-Authors: Shigang Wang, Allen R Kunselman, Joseph B Clark, Jenelle M Izer, Sunil Patel, Linda B Pauliks, Donald Leach, Timothy K Cooper, Ronald P Wilson, Akif Ündar
    Abstract:

    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.

Karl Woitas - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of combined extracorporeal life support and continuous renal replacement therapy on hemodynamic performance and gaseous microemboli handling ability in a simulated neonatal ecls system
    Artificial Organs, 2018
    Co-Authors: Kaitlyn Shank, Karl Woitas, Elizabeth Profeta, Christian Oconnor
    Abstract:

    The objective of this study was to evaluate the hemodynamic performance and gaseous microemboli (GME) handling ability of a simulated neonatal extracorporeal life support (ECLS) circuit with an in-line continuous renal replacement therapy (CRRT) device. The circuit consisted of a Maquet RotaFlow centrifugal pump or HL20 roller pump, Quadrox-iD Pediatric diffusion membrane oxygenator, 8-Fr Arterial Cannula, 10-Fr venous Cannula, and Better-Bladder (BB) with “Y” connector. A second Quadrox-I Adult oxygenator was added postArterial Cannula for GME experiments. The circuit and pseudo-patient were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 40%). All hemodynamic trials were conducted at ECLS flow rates ranging from 200 to 600 mL/min and CRRT flow rate of 75 mL/min at 36°C. Real-time pressure and flow data were recorded with a data acquisition system and GME were detected and characterized using the Emboli Detection and Classification Quantifier System. CRRT was added at distinct locations such that blood entered CRRT between the pump and oxygenator (A), recirculated through the pump (B), or bypassed the pump (C). With the centrifugal pump, all CRRT positions had similar flow rates, mean Arterial pressure (MAP), and total hemodynamic energy (THE) loss. With the roller pump, C demonstrated increased flow rates (293.2–686.4 mL/min) and increased MAP (59.4–75.5 mm Hg) (P < 0.01); B had decreased flow rates (129.7–529.7 mL/min), and MAP (34.2–45.0 mm Hg) (P < 0.01); A maintained the same when compared to without CRRT. At 600 mL/min C lost more THE (81.4%) (P < 0.01) with a larger pressure drop across the oxygenator (95.6 mm Hg) (P < 0.01) than without CRRT (78.3%; 49.1 mm Hg) (P < 0.01). C also demonstrated a poorer GME handling ability using the roller pump, with 87.1% volume and 17.8% count reduction across the circuit, compared to A and B with 99.9% volume and 65.8–72.3% count reduction. These findings suggest that, in contrast to A and B, adding CRRT at position C is unsafe and not advised for clinical use.

  • evaluation of hemodynamic performance of a combined ecls and crrt circuit in seven positions with a simulated neonatal patient
    Artificial Organs, 2018
    Co-Authors: Elizabeth Profeta, Kaitlyn Shank, Christian Oconnor, Karl Woitas
    Abstract:

    As it is common for patients treated with extracorporeal life support (ECLS) to subsequently require continuous renal replacement therapy (CRRT), and neonatal patients encounter limitations due to lack of access points, inclusion of CRRT in the ECLS circuit could provide advanced treatment for this population. The objective of this study was to evaluate an alternative neonatal ECLS circuit containing either a Maquet RotaFlow centrifugal pump or Maquet HL20 roller pump with one of seven configurations of CRRT using the Prismaflex 2000 System. All ECLS circuit setups included a Quadrox-iD Pediatric diffusion membrane oxygenator, a Better Bladder, an 8-Fr Arterial Cannula, a 10-Fr venous Cannula, and 6 feet of ¼-inch diameter Arterial and venous tubing. The circuit was primed with lactated Ringer's solution and packed human red blood cells resulting in a total priming volume of 700 mL for both the circuit and the 3-kg pseudopatient. Hemodynamic data were recorded for ECLS flow rates of 200, 400, and 600 mL/min and a CRRT flow rate of 50 mL/min. When a centrifugal pump is used, the hemodynamic performance of any combined ECLS and CRRT circuit was not significantly different than that of the circuit without CRRT, thus any configuration could potentially be used. However, introduction of CRRT to a circuit containing a roller pump does affect performance properties for some CRRT positions. The circuits with CRRT positions B and G demonstrated decreased total hemodynamic energy (THE) levels at the post-Arterial Cannula site, while positions D and E demonstrated increased post-Arterial Cannula THE levels compared to the circuit without CRRT. CRRT positions A, C, and F did not have significant changes with respect to pre-Arterial Cannula flow and THE levels, compared to the circuit without CRRT. Considering hemodynamic performance, for neonatal combined extracorporeal membrane oxygenation (ECMO) and CRRT circuits with both blood pumps, we recommend the use of CRRT position A due to its hemodynamic similarities to the ECMO circuit without CRRT.

  • in vitro evaluation of an alternative neonatal extracorporeal life support circuit on hemodynamic performance and bubble trap
    Artificial Organs, 2017
    Co-Authors: Shannon B Spencer, Karl Woitas, Kristen Glass
    Abstract:

    The objective of this study was to evaluate an alternative neonatal extracorporeal life support (ECLS) circuit with a RotaFlow centrifugal pump and Better-Bladder (BB) for hemodynamic performance and gaseous microemboli (GME) capture in a simulated neonatal ECLS system. The circuit consisted of a Maquet RotaFlow centrifugal pump, a Quadrox-iD Pediatric diffusion membrane oxygenator, 8 Fr Arterial Cannula, and 10 Fr venous Cannula. A "Y" connector was inserted into the venous line to allow for comparison between BB and no BB. The circuit and pseudopatient were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 35%). All hemodynamic trials were conducted at flow rates ranging from 100 to 600 mL/min at 36°C. Real-time pressure and flow data were recorded using a data acquisition system. For GME testing, 0.5 cc of air was injected via syringe into the venous line. GME were detected and characterized with or without the BB using the Emboli Detection and Classification Quantifier (EDAC) System. Trials were conducted at flow rates ranging from 200 to 500 mL/min. The hemodynamic energy data showed that up to 75.2% of the total hemodynamic energy was lost from the circuit. The greatest pressure drops occurred across the Arterial Cannula and increased with increasing flow rate from 10.1 mm Hg at 100 mL/min to 114.3 mm Hg at 600 mL/min. The EDAC results showed that the BB trapped a significant amount of the GME in the circuit. When the bladder was removed, GME passed through the pump head and the oxygenator to the Arterial line. This study showed that a RotaFlow centrifugal pump combined with a BB can help to significantly decrease the number of GME in a neonatal ECLS circuit. Even with this optimized alternative circuit, a large percentage of the total hemodynamic energy was lost. The Arterial Cannula was the main source of resistance in the circuit.

John L Myers - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of centrifugal blood pumps in term of hemodynamic performance using simulated neonatal and pediatric ecmo circuits
    Artificial Organs, 2020
    Co-Authors: Morgan K Moroi, John L Myers
    Abstract:

    The objective of this translational study was to evaluate the FDA-approved PediMag, CentriMag, and RotaFlow centrifugal blood pumps in terms of hemodynamic performance using simulated neonatal and pediatric extracorporeal membrane oxygenation (ECMO) circuits with different sizes of Arterial and venous Cannulae. Cost of disposable pump heads was another important variable for this particular study. The experimental circuit was composed of one of the centrifugal pump heads, a polymethylpentene membrane oxygenator, neonatal and pediatric Arterial/venous Cannulae, and 1/4-inch ID tubing. Circuits were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 35%). Trials were conducted at 36°C using the three pump heads and different Cannulae (Arterial/venous Cannulae: 8 Fr/18 Fr, 10 Fr/20 Fr, and 12 Fr/22 Fr) at various flow rates (200-2400 mL/min, 200 mL/min increments) and rotational speeds. Pseudo patient pressure was 60 mm Hg. Real-time pressure and flow data were recorded for analysis. The RotaFlow pump had a higher pressure head and flow range compared with the PediMag and CentriMag pumps at the same rotational speed and identical experimental settings (P < 0.001). The PediMag pump had lower flow output than others (P < 0.001). Small-caliber Arterial Cannulae and higher flow rates predictably created higher circuit pressures and pressure drops. There was no significant difference in hemodynamic energy delivered to the pseudo patient with each of the three pumps. The Arterial Cannula had the highest pressure drop and hemodynamic energy loss in the circuit when compared to the oxygenator and Arterial tubing. The RotaFlow centrifugal pump had a significantly better hemodynamic performance when compared to the PediMag and CentriMag blood pumps at identical experimental conditions in simulated neonatal and pediatric ECMO settings. In addition, the cost of the RotaFlow pump head ($400) is 20 to 30-fold less than the other centrifugal pumps [CentriMag ($12 000) or PediMag ($8000)] that were evaluated in this translational study.

  • comparison of two types of neonatal extracorporeal life support systems with pulsatile and nonpulsatile flow
    Artificial Organs, 2009
    Co-Authors: Nikkole Haines, Shigang Wang, John L Myers
    Abstract:

    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.