The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Akif Undar - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of two neonatal ecmo circuits using a Roller or centrifugal Pump with three different in line hemoconcentrators for maintaining hemodynamic energy delivery to the patient
Artificial Organs, 2018Co-Authors: Madison Force, Akif Undar, David A Palanzo, Allen R Kunselman, Shigang Wang, Morgan MoroiAbstract:The objective of this study was to compare three different hemoconcentrators (Hemocor HPH 400, Mini, and Junior) with two different neonatal ECMO circuits using a Roller or a centrifugal Pump at different pseudo-patient pressures and flow rates in terms of hemodynamic properties. This evidence-based research is necessary to optimize the ECMO circuitry for neonates. The circuits used a 300-mL soft-shell reservoir as a pseudo-patient approximating the blood volume of a 3 kg neonate, two blood Pumps, and a Quadrox-iD Pediatric oxygenator with three different in-line hemoconcentrators (Hemocor HPH 400, Mini, and Junior). One circuit used a Maquet H20 Roller Pump and another circuit used a Maquet RotaFlow centrifugal Pump. The circuit was primed with lactated Ringer's solution followed by heparinized packed red blood cells with a hematocrit of 40%. The pseudo-patient's pressure was manually maintained at 40, 60, or 80 mm Hg and the flow rate was maintained at 200, 400, or 600 mL/min with a circuit temperature of 36°C. Pressure and flow data was recorded using a custom-made data acquisition device. Mean pressures, diverted blood flow, pressure drops, and total hemodynamic energy (THE) were calculated for each experimental condition. The Roller Pump and centrifugal Pump performed similarly for all hemodynamic properties with all experimental conditions. The Hemocor HPH Junior hemoconcentrator added the highest resistance to the circuit. The Hemocor HPH Junior provided the highest circuit pressures, lowest diverted blood flow, highest pressure drop across the circuit, and highest THE generated by the Pump. The Hemocor HPH 400 added the least resistance to the circuit, providing the lowest circuit pressures, more diverted flow, lowest pressure drop, and the lowest THE generated by the Pump. However, the THE delivered to the patient was the same for the three hemoconcentrators. While the three hemoconcentrators performed differently in terms of hemodynamic properties throughout the circuit, the THE transmitted to the patient was similar for all three hemoconcentrators due to the consistent pseudo-patient's pressure that was manually maintained for each trial. While the THE delivered to the patient indicates similar perfusion for these patients with any of the three hemoconcentrators, the differences in added resistance to the circuit may impact the decision of which hemoconcentrator is used. There was no clinically significant difference between the two circuits with the Roller versus centrifugal Pump in terms of hemodynamic properties in this study. Further in vivo research is warranted to confirm our findings.
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evaluation of hemodynamic performance of a combined ecls and crrt circuit in seven positions with a simulated neonatal patient
Artificial Organs, 2018Co-Authors: Elizabeth Profeta, John L Myers, Allen R Kunselman, Shigang Wang, Karl Woitas, Kaitlyn Shank, Christian Oconnor, Akif UndarAbstract: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.
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does an open recirculation line affect the flow rate and pressure in a neonatal extracorporeal life support circuit with a centrifugal or Roller Pump
Artificial Organs, 2017Co-Authors: Shigang Wang, Allen R Kunselman, Shannon B Spencer, Karl Woitas, Kristen Glass, Akif UndarAbstract:The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 Roller Pump (RP group) or a RotaFlow centrifugal Pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). Trials were conducted at flow rates ranging from 200 to 600 mL/min (200 mL/min increments) with a closed or open recirculation line at 36°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. In the RP group, the preoxygenator flow did not change when the recirculation line was open while the prearterial cannula flow decreased by 15.7-20.0% (P < 0.01). Circuit pressure, total circuit pressure drop, and hemodynamic energy delivered to patients also decreased (P < 0.01). In the CP group, the prearterial cannula flow did not change while preoxygenator flow increased by 13.6-18.8% (P < 0.01). Circuit pressure drop and hemodynamic energy transmission remained the same. The results showed that the shunt of an open recirculation line could decrease perfusion flow in patients in the ECLS circuit using a Roller Pump, but did not change perfusion flow in the circuit using a centrifugal Pump. An additional flow sensor is needed to monitor perfusion flow in patients if any shunts exist in the ECLS circuit.
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Ündar A. Extracorporeal life support systems: alternative vs. conventional circuits. Perfusion
2016Co-Authors: Sameer Khan, Feng Qiu, Rahul Vasavada, Allan Kunselman, Akif UndarAbstract:Emerging technologies and practices for pediatric and neonatal extracorporeal life support (ECLS) are promising. This experiment sought to compare the Medtronic 0800 silicon rubber membrane oxygenator to the Quadrox-iD Pediatric oxygenator in the conventional Roller Pump circuit, as well as comparing the conventional circuit to an alternative circuit. Three circuits were set up in the experiment. Two conventional Roller Pump circuits were used to compare the two oxygenators and an alternative circuit consisting of the Quadrox-iD Pediatric oxygenator and Maquet Rotaflow centrifugal Pump system was used to identify differences between circuits. All three circuits were primed with Lactated Ringers ’ solution and human blood, with an hematocrit of 40%. Testing occurred at flow rates of 250, 500, and 750 ml/ min at 37°C for mean arterial line pressures of 60, 80, and 100 mmHg. The results of the experiment showed lower pressure drops and greater retention of total hemodynamic energy (THE) across the Quadrox-iD Pediatric oxygenator compared to the Medtronic 0800 oxygenator. Furthermore, the centrifugal Pump used in the alternative circuit showed no back flow at flow rates as low as 250 ml/min while, on the other hand, rpm levels were kept below 2200 for flow rates as high as 750 ml/min. Findings support the usage of the Quadrox-iD Pediatric oxygenator in a circuit utilizing the Maquet Rotaflow centrifugal Pump system due to lower pressure drops and greater percentage of THE retained across the circuit. Additional advantages of the alternative circuit include rapid set-up time, easy transport, lower priming volumes, and no gravity-dependent venous drainage system so that it can be situated in close proximity to and at the level of the patient
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an original versatile nonocclusive pressure regulated blood Roller Pump for extracorporeal perfusion
Artificial Organs, 2014Co-Authors: Yves Durandy, Shigang Wang, Akif UndarAbstract:Currently, only a small number of centrifugal Pumps are being used for hemodynamic and/or respiratory support, but all of them have limitations. This article aims to present the Rhone-Poulenc 06 nonocclusive pressure-regulated blood Pump. This Pump was developed in France in the 1970s and used for decades in perfusion for cardiopulmonary bypass procedures, cardiac or lung assist as well as venovenous bypass during liver transplant. The intrinsic properties of this Pump allowed us to describe a new technique for extracorporeal lung support in the 1980s, using a single cannula tidal flow venovenous bypass. This Pump compared favorably with conventional Pumps in terms of flow and pressure, hemolysis, pulsatility, safety, and cost-effectiveness. We believe that this simple Pump could be an alternative to more sophisticated and expensive devices.
Shigang Wang - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of two neonatal ecmo circuits using a Roller or centrifugal Pump with three different in line hemoconcentrators for maintaining hemodynamic energy delivery to the patient
Artificial Organs, 2018Co-Authors: Madison Force, Akif Undar, David A Palanzo, Allen R Kunselman, Shigang Wang, Morgan MoroiAbstract:The objective of this study was to compare three different hemoconcentrators (Hemocor HPH 400, Mini, and Junior) with two different neonatal ECMO circuits using a Roller or a centrifugal Pump at different pseudo-patient pressures and flow rates in terms of hemodynamic properties. This evidence-based research is necessary to optimize the ECMO circuitry for neonates. The circuits used a 300-mL soft-shell reservoir as a pseudo-patient approximating the blood volume of a 3 kg neonate, two blood Pumps, and a Quadrox-iD Pediatric oxygenator with three different in-line hemoconcentrators (Hemocor HPH 400, Mini, and Junior). One circuit used a Maquet H20 Roller Pump and another circuit used a Maquet RotaFlow centrifugal Pump. The circuit was primed with lactated Ringer's solution followed by heparinized packed red blood cells with a hematocrit of 40%. The pseudo-patient's pressure was manually maintained at 40, 60, or 80 mm Hg and the flow rate was maintained at 200, 400, or 600 mL/min with a circuit temperature of 36°C. Pressure and flow data was recorded using a custom-made data acquisition device. Mean pressures, diverted blood flow, pressure drops, and total hemodynamic energy (THE) were calculated for each experimental condition. The Roller Pump and centrifugal Pump performed similarly for all hemodynamic properties with all experimental conditions. The Hemocor HPH Junior hemoconcentrator added the highest resistance to the circuit. The Hemocor HPH Junior provided the highest circuit pressures, lowest diverted blood flow, highest pressure drop across the circuit, and highest THE generated by the Pump. The Hemocor HPH 400 added the least resistance to the circuit, providing the lowest circuit pressures, more diverted flow, lowest pressure drop, and the lowest THE generated by the Pump. However, the THE delivered to the patient was the same for the three hemoconcentrators. While the three hemoconcentrators performed differently in terms of hemodynamic properties throughout the circuit, the THE transmitted to the patient was similar for all three hemoconcentrators due to the consistent pseudo-patient's pressure that was manually maintained for each trial. While the THE delivered to the patient indicates similar perfusion for these patients with any of the three hemoconcentrators, the differences in added resistance to the circuit may impact the decision of which hemoconcentrator is used. There was no clinically significant difference between the two circuits with the Roller versus centrifugal Pump in terms of hemodynamic properties in this study. Further in vivo research is warranted to confirm our findings.
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evaluation of hemodynamic performance of a combined ecls and crrt circuit in seven positions with a simulated neonatal patient
Artificial Organs, 2018Co-Authors: Elizabeth Profeta, John L Myers, Allen R Kunselman, Shigang Wang, Karl Woitas, Kaitlyn Shank, Christian Oconnor, Akif UndarAbstract: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.
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does an open recirculation line affect the flow rate and pressure in a neonatal extracorporeal life support circuit with a centrifugal or Roller Pump
Artificial Organs, 2017Co-Authors: Shigang Wang, Allen R Kunselman, Shannon B Spencer, Karl Woitas, Kristen Glass, Akif UndarAbstract:The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 Roller Pump (RP group) or a RotaFlow centrifugal Pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). Trials were conducted at flow rates ranging from 200 to 600 mL/min (200 mL/min increments) with a closed or open recirculation line at 36°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. In the RP group, the preoxygenator flow did not change when the recirculation line was open while the prearterial cannula flow decreased by 15.7-20.0% (P < 0.01). Circuit pressure, total circuit pressure drop, and hemodynamic energy delivered to patients also decreased (P < 0.01). In the CP group, the prearterial cannula flow did not change while preoxygenator flow increased by 13.6-18.8% (P < 0.01). Circuit pressure drop and hemodynamic energy transmission remained the same. The results showed that the shunt of an open recirculation line could decrease perfusion flow in patients in the ECLS circuit using a Roller Pump, but did not change perfusion flow in the circuit using a centrifugal Pump. An additional flow sensor is needed to monitor perfusion flow in patients if any shunts exist in the ECLS circuit.
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an original versatile nonocclusive pressure regulated blood Roller Pump for extracorporeal perfusion
Artificial Organs, 2014Co-Authors: Yves Durandy, Shigang Wang, Akif UndarAbstract:Currently, only a small number of centrifugal Pumps are being used for hemodynamic and/or respiratory support, but all of them have limitations. This article aims to present the Rhone-Poulenc 06 nonocclusive pressure-regulated blood Pump. This Pump was developed in France in the 1970s and used for decades in perfusion for cardiopulmonary bypass procedures, cardiac or lung assist as well as venovenous bypass during liver transplant. The intrinsic properties of this Pump allowed us to describe a new technique for extracorporeal lung support in the 1980s, using a single cannula tidal flow venovenous bypass. This Pump compared favorably with conventional Pumps in terms of flow and pressure, hemolysis, pulsatility, safety, and cost-effectiveness. We believe that this simple Pump could be an alternative to more sophisticated and expensive devices.
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in vitro comparison of the delivery of gaseous microemboli and hemodynamic energy for a diagonal and a Roller Pump during simulated infantile cardiopulmonary bypass procedures
Artificial Organs, 2014Co-Authors: Ranjodh S Dhami, Akif Undar, Allen R Kunselman, Shigang WangAbstract:Cardiopulmonary bypass (CPB) is used for a variety of procedures in pediatric patients. Flow settings of the CPB Pump have dramatic effects on patient outcome, and gaseous microemboli delivery within the CPB circuit has been linked to neurological complications. To ensure the ongoing improvement of pediatric CPB, consistent evaluation and improvement of the equipment is necessary. In this study we analyze the Jostra HL-20 Roller Pump (Jostra USA, Austin, TX, USA) and a Medos Deltastream DP3 diagonal Pump (MEDOS Medizintechnik AG, Stolberg, Germany) which has not yet received Food and Drug Administration approval. An infant CPB model with heparinized human blood is used to quantify the gaseous microemboli delivery (via an Emboli Detection and Classification Quantifier), as well as the hemodynamic energy delivered under flow rates of 400, 800, and 1200 mL/min. Results show that at most flow settings the DP3 delivers fewer microemboli than the Jostra Roller Pump at the pre-oxygenator site, with an exception at 1200 mL/min under pulsatile mode. The total volume and the number of gaseous microemboli greater than 40 μm in diameter were lower in the DP3 group. The HL-20 exhibits less stolen blood flow (except at 1200 mL/min) and oxygenator pressure drops in both pulsatile and nonpulsatile mode. Additionally, under pulsatile flow the DP3 delivers greater surplus hemodynamic energy. Both Pumps produce relatively few microemboli and deliver adequate hemodynamic energy to the pseudo-patient, with the DP3 performing slightly better under most flow settings.
Allen R Kunselman - One of the best experts on this subject based on the ideXlab platform.
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in vitro comparison of two neonatal ecmo circuits using a Roller or centrifugal Pump with three different in line hemoconcentrators for maintaining hemodynamic energy delivery to the patient
Artificial Organs, 2018Co-Authors: Madison Force, Akif Undar, David A Palanzo, Allen R Kunselman, Shigang Wang, Morgan MoroiAbstract:The objective of this study was to compare three different hemoconcentrators (Hemocor HPH 400, Mini, and Junior) with two different neonatal ECMO circuits using a Roller or a centrifugal Pump at different pseudo-patient pressures and flow rates in terms of hemodynamic properties. This evidence-based research is necessary to optimize the ECMO circuitry for neonates. The circuits used a 300-mL soft-shell reservoir as a pseudo-patient approximating the blood volume of a 3 kg neonate, two blood Pumps, and a Quadrox-iD Pediatric oxygenator with three different in-line hemoconcentrators (Hemocor HPH 400, Mini, and Junior). One circuit used a Maquet H20 Roller Pump and another circuit used a Maquet RotaFlow centrifugal Pump. The circuit was primed with lactated Ringer's solution followed by heparinized packed red blood cells with a hematocrit of 40%. The pseudo-patient's pressure was manually maintained at 40, 60, or 80 mm Hg and the flow rate was maintained at 200, 400, or 600 mL/min with a circuit temperature of 36°C. Pressure and flow data was recorded using a custom-made data acquisition device. Mean pressures, diverted blood flow, pressure drops, and total hemodynamic energy (THE) were calculated for each experimental condition. The Roller Pump and centrifugal Pump performed similarly for all hemodynamic properties with all experimental conditions. The Hemocor HPH Junior hemoconcentrator added the highest resistance to the circuit. The Hemocor HPH Junior provided the highest circuit pressures, lowest diverted blood flow, highest pressure drop across the circuit, and highest THE generated by the Pump. The Hemocor HPH 400 added the least resistance to the circuit, providing the lowest circuit pressures, more diverted flow, lowest pressure drop, and the lowest THE generated by the Pump. However, the THE delivered to the patient was the same for the three hemoconcentrators. While the three hemoconcentrators performed differently in terms of hemodynamic properties throughout the circuit, the THE transmitted to the patient was similar for all three hemoconcentrators due to the consistent pseudo-patient's pressure that was manually maintained for each trial. While the THE delivered to the patient indicates similar perfusion for these patients with any of the three hemoconcentrators, the differences in added resistance to the circuit may impact the decision of which hemoconcentrator is used. There was no clinically significant difference between the two circuits with the Roller versus centrifugal Pump in terms of hemodynamic properties in this study. Further in vivo research is warranted to confirm our findings.
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evaluation of hemodynamic performance of a combined ecls and crrt circuit in seven positions with a simulated neonatal patient
Artificial Organs, 2018Co-Authors: Elizabeth Profeta, John L Myers, Allen R Kunselman, Shigang Wang, Karl Woitas, Kaitlyn Shank, Christian Oconnor, Akif UndarAbstract: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.
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does an open recirculation line affect the flow rate and pressure in a neonatal extracorporeal life support circuit with a centrifugal or Roller Pump
Artificial Organs, 2017Co-Authors: Shigang Wang, Allen R Kunselman, Shannon B Spencer, Karl Woitas, Kristen Glass, Akif UndarAbstract:The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 Roller Pump (RP group) or a RotaFlow centrifugal Pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). Trials were conducted at flow rates ranging from 200 to 600 mL/min (200 mL/min increments) with a closed or open recirculation line at 36°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. In the RP group, the preoxygenator flow did not change when the recirculation line was open while the prearterial cannula flow decreased by 15.7-20.0% (P < 0.01). Circuit pressure, total circuit pressure drop, and hemodynamic energy delivered to patients also decreased (P < 0.01). In the CP group, the prearterial cannula flow did not change while preoxygenator flow increased by 13.6-18.8% (P < 0.01). Circuit pressure drop and hemodynamic energy transmission remained the same. The results showed that the shunt of an open recirculation line could decrease perfusion flow in patients in the ECLS circuit using a Roller Pump, but did not change perfusion flow in the circuit using a centrifugal Pump. An additional flow sensor is needed to monitor perfusion flow in patients if any shunts exist in the ECLS circuit.
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in vitro comparison of the delivery of gaseous microemboli and hemodynamic energy for a diagonal and a Roller Pump during simulated infantile cardiopulmonary bypass procedures
Artificial Organs, 2014Co-Authors: Ranjodh S Dhami, Akif Undar, Allen R Kunselman, Shigang WangAbstract:Cardiopulmonary bypass (CPB) is used for a variety of procedures in pediatric patients. Flow settings of the CPB Pump have dramatic effects on patient outcome, and gaseous microemboli delivery within the CPB circuit has been linked to neurological complications. To ensure the ongoing improvement of pediatric CPB, consistent evaluation and improvement of the equipment is necessary. In this study we analyze the Jostra HL-20 Roller Pump (Jostra USA, Austin, TX, USA) and a Medos Deltastream DP3 diagonal Pump (MEDOS Medizintechnik AG, Stolberg, Germany) which has not yet received Food and Drug Administration approval. An infant CPB model with heparinized human blood is used to quantify the gaseous microemboli delivery (via an Emboli Detection and Classification Quantifier), as well as the hemodynamic energy delivered under flow rates of 400, 800, and 1200 mL/min. Results show that at most flow settings the DP3 delivers fewer microemboli than the Jostra Roller Pump at the pre-oxygenator site, with an exception at 1200 mL/min under pulsatile mode. The total volume and the number of gaseous microemboli greater than 40 μm in diameter were lower in the DP3 group. The HL-20 exhibits less stolen blood flow (except at 1200 mL/min) and oxygenator pressure drops in both pulsatile and nonpulsatile mode. Additionally, under pulsatile flow the DP3 delivers greater surplus hemodynamic energy. Both Pumps produce relatively few microemboli and deliver adequate hemodynamic energy to the pseudo-patient, with the DP3 performing slightly better under most flow settings.
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a nonocclusive inexpensive pediatric pulsatile Roller Pump for cardiopulmonary bypass extracorporeal life support and left right ventricular assist systems
Artificial Organs, 2013Co-Authors: Shigang Wang, Allen R Kunselman, Yves Durandy, Akif UndarAbstract:A simple, inexpensive pediatric pulsatile Roller blood Pump has been utilized for routine cardiopulmonary bypass (CPB) procedures, extracorporeal life support (ECLS), and left/right ventricular assist systems (LVAS/RVAS) for decades in France. This particular nonocclusive pulsatile system has many advantages including several safety features for patients as well as an extremely lower cost. The objective of this study is to evaluate the performance of this particular system for CPB, ECLS, and LVAS/RVAS in pulsatile mode. This pediatric nonocclusive system was evaluated with Pump flow rates of 500, 750, and 1000 mL/min under normothermic (35°C) and hypothermic (25°C) conditions in CPB, ECLS, and LVAS/RVAS circuits using clinical disposables and settings. Energy equivalent pressure (EEP), surplus homodynamic energy (SHE), and total hemodynamic energy (THE) were calculated for each experimental stage. The Pump generated near physiological quality of pulsatile flow without backflow in the three simulated pediatric circuits. With increased flow rates, more hemodynamic energy was delivered to the pseudo patient. This particular nonocclusive pediatric pulsatile system performed well during all of the experimental conditions and generated adequate quality pulsatile pressure-flow waveforms using CPB, ECLS, and LVAS/RVAS circuitry. Although this novel concept was first introduced in the 1990s, we believe that there is still need for this technology (with engineering modifications) because of significant advantages including safety and cost.
Ravi R Thiagarajan - One of the best experts on this subject based on the ideXlab platform.
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outcomes of infants supported with extracorporeal membrane oxygenation using centrifugal versus Roller Pumps an analysis from the extracorporeal life support organization registry
Pediatric Critical Care Medicine, 2019Co-Authors: Conor P Ohalloran, Ravi R Thiagarajan, Vamsi V Yarlagadda, Ryan P Barbaro, Viviane G Nasr, Peter Rycus, Marc Anders, Peta M A AlexanderAbstract:OBJECTIVES To determine whether mortality differs between Roller and centrifugal Pumps used during extracorporeal membrane oxygenation in infants weighing less than 10 kg. DESIGN Retrospective propensity-matched cohort study. SETTING All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization. PATIENTS All patients less than 10 kg supported on extracorporeal membrane oxygenation during 2011-2016 within Extracorporeal Life Support Organization Registry. INTERVENTIONS Centrifugal and Roller Pump recipients were propensity matched (1:1) based on predicted probability of receiving a centrifugal Pump using demographic variables, indication for extracorporeal membrane oxygenation, central versus peripheral cannulation, and pre-extracorporeal membrane oxygenation patient management. MEASUREMENTS AND MAIN RESULTS A total of 12,890 patients less than 10 kg were supported with extracorporeal membrane oxygenation within the Extracorporeal Life Support Organization registry during 2011-2016. Patients were propensity matched into a cohort of 8,366. Venoarterial and venovenous extracorporeal membrane oxygenation runs were propensity matched separately. The propensity-matched cohorts were similar except earlier year of extracorporeal membrane oxygenation (standardized mean difference, 0.49) in the Roller Pump group. Within the propensity-matched cohort, survival to discharge was lower in the centrifugal Pump group (57% vs 59%; odds ratio, 0.91; 95% CI, 0.83-0.99; p = 0.04). Hemolytic, infectious, limb injury, mechanical, metabolic, neurologic, pulmonary, and renal complications were more frequent in the centrifugal Pump group. Hemorrhagic complications were similar between groups. Hemolysis mediated the relationship between centrifugal Pumps and mortality (indirect effect, 0.023; p < 0.001). CONCLUSIONS In this propensity score-matched cohort study of 8,366 extracorporeal membrane oxygenation recipients weighing less than 10 kg, those supported with centrifugal Pumps had increased mortality and extracorporeal membrane oxygenation complications. Hemolysis was evaluated as a potential mediator of the relationship between centrifugal Pump use and mortality and met criteria for full mediation.
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outcomes of neonates undergoing extracorporeal membrane oxygenation support using centrifugal versus Roller blood Pumps
The Annals of Thoracic Surgery, 2012Co-Authors: Cindy Barrett, James Jaggers, Peter Rycus, Francis E Cook, Dionne A Graham, Satish K Rajagopal, Christopher S Almond, John D Seeger, Ravi R ThiagarajanAbstract:Background Advances in centrifugal blood Pump technology have led to increased use of centrifugal Pumps in extracorporeal membrane oxygenation (ECMO) circuits. Their efficacy and safety in critically ill neonates remains unknown. Blood cell trauma leading to hemolysis may result in end-organ injury in critically ill neonates receiving centrifugal Pump ECMO. We hypothesized that neonates undergoing ECMO support using centrifugal Pumps were at increased odds of hemolysis and subsequent end-organ injury. Methods Children 30 days of age or younger who received support with venoarterial ECMO and were reported to the Extracorporeal Life Support Registry during 2007 to 2009 underwent propensity score matching (Greedy matching 1:1) using pre-ECMO support characteristics. Results A total of 1,592 neonates receiving ECMO (centrifugal Pump=163 and Roller Pump=1,492) were identified. Significant differences in demographic, presupport, and cannulation variables were present before matching. One hundred seventy-six neonates who were supported using either centrifugal (n = 88) or Roller Pumps (n = 88) were matched using propensity scoring. No significant differences in demographic, presupport, or cannulation variables were present after matching. Neonates undergoing support using centrifugal Pumps had increased odds of hemolysis (odds ratio [OR], 7.7 [2.8–21.2]), hyperbilirubinemia (OR, 20.8 [2.7–160.4]), hypertension (OR, 3.2 [1.3–8.0]), and acute renal failure (OR, 2.4 [1.1–5.6]). Survival to discharge was not different between Pump types. Conclusions Use of ECMO using centrifugal Pumps is associated with increased odds of hemolysis that likely contributes to other end-organ injury. Research into the optimal use of centrifugal Pumps and strategies to prevent support-related complications need to be investigated.
Marden Leonardi Lopes - One of the best experts on this subject based on the ideXlab platform.
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SACEC : sistema de apoio a circulação extracorporea
2017Co-Authors: Marden Leonardi LopesAbstract:Resumo: Todos os dias milhares de cirurgias cardíacas envolvendo circulação extracorpórea (CEC) são realizadas ao redor do mundo, mas a técnica ainda apresenta problemas relacionados à segurança. Um dos principais tipos de acidentes que podem ocorrer em circulação extracorpórea envolve os oxigenadores e consiste no esvaziamento rápido do reservatório de sangue sem que o perfusionista (operador de CEC) perceba, que provoca a entrada maciça de ar no paciente (embolia aérea maciça), podendo resultar em seqüelas graves ou até mesmo em sua morte. Este acidente é mais comum quando utilizada a bomba de roletes, sendo raros os relatos de casos de embolia aérea maciça com bomba centrífuga. Procurando aumentar a segurança do procedimento de CEC em relação à prevenção deste tipo de acidente, foi desenvolvido o SACEC (Sistema de Apoio à Circulação Extracorpórea), que opera juntamente com uma bomba de roletes e oxigenadores de bolha ou membrana para utilização em adultos. o SACEC é um equipamento microcontrolado que, a partir da medição discreta do nível de sangue no reservatório do oxigenador (com resolução de 100 ml) utilizando um transdutor ultra-sônico de 40 KHz (também desenvolvido neste trabalho) colocado no topo do reservatório, procura manter o nível de sangue acima do nível mínimo de segurança (400 ml nos oxigenadores para adultos) por meio do controle automático da rotação da bomba sistêmica (desligando a bomba se o nível cai abaixo de 500 ml), ou apenas realiza a monitoração do nível no reservatório e da rotação da bomba... Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital @@Abstract:Thousands of cardiac surgeries involving extracorporeal circulation are perfonned everyday around the world, but the technique still presents safety problems. Oxygenator accidents are among the major accidents that can occur in extracorporeal circulation, being the most serious the rapid and inadvertent emptying of the blood reservoir, that causes massive infusion of air into the patient (massive air embolism) and can result in serious consequences and even patient death. This accident is most common when Roller Pump is used, being rare reports of massive air embolism with centrifugal Pump. Aiming at increasing the safety related to the prevention of this accident, it has been developed the SACEC (Extracorporeal Circulation Support System), that works together with a Roller Pump and bubble or membrane oxygenators for adults. SACEC is a microcontRoller based equipment that, based on the discrete blood leveI measurement in the oxygenator reservoir (with 100 ml resolution) using a 40 KHz ultrasonic transducer (also developed in this work) placed on the oxygenator top, tries to keep the blood leveI above the minimum safety leveI (400 ml in oxygenators for adults) by means of the automatic control of the systemic Pump rotation (turning off the Pump if the leveI falls below 500 ml), or only performs the reservoir blood leveI and Pump rotation monitoring... Note: The complete abstract is available with the full electronic digital thesis or dissertation
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SACEC : sistema de apoio a circulação extracorporea
Universidade Estadual de Campinas . Faculdade de Engenharia Elétrica e de Computação, 1998Co-Authors: Marden Leonardi LopesAbstract:Todos os dias milhares de cirurgias cardíacas envolvendo circulação extracorpórea (CEC) são realizadas ao redor do mundo, mas a técnica ainda apresenta problemas relacionados à segurança. Um dos principais tipos de acidentes que podem ocorrer em circulação extracorpórea envolve os oxigenadores e consiste no esvaziamento rápido do reservatório de sangue sem que o perfusionista (operador de CEC) perceba, que provoca a entrada maciça de ar no paciente (embolia aérea maciça), podendo resultar em seqüelas graves ou até mesmo em sua morte. Este acidente é mais comum quando utilizada a bomba de roletes, sendo raros os relatos de casos de embolia aérea maciça com bomba centrífuga. Procurando aumentar a segurança do procedimento de CEC em relação à prevenção deste tipo de acidente, foi desenvolvido o SACEC (Sistema de Apoio à Circulação Extracorpórea), que opera juntamente com uma bomba de roletes e oxigenadores de bolha ou membrana para utilização em adultos. o SACEC é um equipamento microcontrolado que, a partir da medição discreta do nível de sangue no reservatório do oxigenador (com resolução de 100 ml) utilizando um transdutor ultra-sônico de 40 KHz (também desenvolvido neste trabalho) colocado no topo do reservatório, procura manter o nível de sangue acima do nível mínimo de segurança (400 ml nos oxigenadores para adultos) por meio do controle automático da rotação da bomba sistêmica (desligando a bomba se o nível cai abaixo de 500 ml), ou apenas realiza a monitoração do nível no reservatório e da rotação da bomba... Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digitalThousands of cardiac surgeries involving extracorporeal circulation are perfonned everyday around the world, but the technique still presents safety problems. Oxygenator accidents are among the major accidents that can occur in extracorporeal circulation, being the most serious the rapid and inadvertent emptying of the blood reservoir, that causes massive infusion of air into the patient (massive air embolism) and can result in serious consequences and even patient death. This accident is most common when Roller Pump is used, being rare reports of massive air embolism with centrifugal Pump. Aiming at increasing the safety related to the prevention of this accident, it has been developed the SACEC (Extracorporeal Circulation Support System), that works together with a Roller Pump and bubble or membrane oxygenators for adults. SACEC is a microcontRoller based equipment that, based on the discrete blood leveI measurement in the oxygenator reservoir (with 100 ml resolution) using a 40 KHz ultrasonic transducer (also developed in this work) placed on the oxygenator top, tries to keep the blood leveI above the minimum safety leveI (400 ml in oxygenators for adults) by means of the automatic control of the systemic Pump rotation (turning off the Pump if the leveI falls below 500 ml), or only performs the reservoir blood leveI and Pump rotation monitoring... Note: The complete abstract is available with the full electronic digital thesis or dissertation
