Evaluation of Conventional Nonpulsatile and Novel Pulsatile Extracorporeal Life Support Systems in a Simulated Pediatric Extracorporeal Life Support Model

Abstract

The objective of this study is to evaluate two extracorporeal life support (ECLS) circuits and determine the effect of pulsatile flow on pressure drop, flow/pressure waveforms, and hemodynamic energy levels in a pediatric pseudopatient. One ECLS circuit consisted of a Medos Deltastream DP3 diagonal pump and Hilite 2400 LT oxygenator with arterial/venous tubing. The second circuit consisted of a Maquet RotaFlow centrifugal pump and Quadrox-iD Pediatric oxygenator with arterial/venous tubing. A 14Fr Medtronic Bio-Medicus one-piece pediatric arterial cannula was used for both circuits. All trials were conducted at flow rates ranging from 500 to 2800 mL/min using pulsatile or nonpulsatile flow. The post-cannula pressure was maintained at 50 mm Hg. Blood temperature was maintained at 36°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. The results showed that the Deltastream DP3 circuit produced surplus hemodynamic energy (SHE) in pulsatile mode at all flow rates, with greater SHE delivery at lower flow rates. Neither circuit produced SHE in nonpulsatile mode. The Deltastream DP3 pump also demonstrated consistently higher total hemodynamic energy at the pre-oxygenator site in pulsatile mode and a lesser pressure drop across the oxygenator. The Deltastream DP3 pump generated physiological pulsatility without backflow and provided increased hemodynamic energy. This novel ECLS circuit demonstrates suitable in vitro performance and adaptability to a wide range of pediatric patients.