Impact of Pulsatile Flow on Hemodynamic Energy in a Medos Deltastream DP3 Pediatric Extracorporeal Life Support System

Abstract

The Medos Deltastream DP3 system is made up of a novel diagonal pump and hollow-membrane oxygenator that provides nonpulsatile and pulsatile flows for extracorporeal life support (ECLS). The objectives of this study are to (i) evaluate the efficacy of the hemodynamic energy provided by Medos Deltastream DP3 system in nonpulsatile and pulsatile mode and (ii) to evaluate the pulsatile mode under different frequencies. The experimental ECLS circuit was used in this study, primed with Ringer's lactate and packed red blood cells (hematocrit 35%). All trials were conducted at flow rates of 500, 1000, 1500, and 2000 mL/min with modified pulsatile frequencies of 60, 70, 80, and 90 bpm at 36°C. Simultaneous blood flow and pressures at the pre/postoxygenator and pre/postcannula sites were recorded for quantification of the pulsatile perfusion-generated energy-equivalent pressure (EEP), surplus hemodynamic energy (SHE), and total hemodynamic energy (THE). The experiments showed that under pulsatile flow conditions, at all flow rates and frequencies, (i) the EEP, SHE, and THE were significantly higher when compared with the nonpulsatile group and (ii) the pressure drop was minimal at lower flow rates and lower pulsatile frequencies but was significant when either the flow rate or the pulsatile frequency was increased. The Medos Deltastream DP3 System can provide nonpulsatile flow and physiologic quality pulsatile flow for pediatric ECLS. When the Medos DP3 pediatric ECLS system is used with pulsatile flow, there is more surplus hemodynamic energy and total hemodynamic energy than nonpulsatile flow.