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Letzte Veröffentlichungen:

Novel Pulsatile Diagonal Pump for Pediatric Extracorporeal Life Support System

Wang et al., Artificial Organs; 2013, 37(1):37–47

A novel pulsatile rotary flow pump has been used in clinical extracorporeal life support (ECLS) in Europe. The objective of this study is to evaluate the Medos Deltastream DP3 diagonal pump (Medos Medizintechnik AG, Stolberg, Germany) in a simulated pediatric ECLS system. The ECLS circuit consisted of a Medos Hilite 800LT hollow fiber membrane oxygenator (Medos Medizintechnik AG), a Medos Deltastream DP3 diagonal pump, a 10Fr Terumo TenderFlow Pediatric Arterial Cannula (Terumo Corporation, Tokyo, Japan), and an arterial/venous tubing. All trials were conducted at flow rates ranging from 200-800 mL/min (in 200 mL/min increments) under a blood temperature of 35°C using human blood (hematocrit 40%). The postcannula pressure was maintained 60 mm Hg by a Hoffman clamp. Real-time pressure and flow data were recorded using a Labview-based acquisition system (National Instruments, Austin, TX, USA). The results showed that the Medos Deltastream DP3 can generate effective pulsatile flow without backflow, provide higher flow rates and pressures than nonpulsatile flow, and then create surplus hemodynamic energy and more total hemodynamic energy than nonpulsatile flow. Pulsatility increased with increased speed differential values and flow rates, while the oxygenator pressure drop increased at an acceptable level. The Medos Deltastream DP3 diagonal pump can provide adequate quality of pulsatility without backflow, and generate more hemodynamic energy under pulsatile mode in a simulated pediatric ECLS system.

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Extrakorporale Membran Oxygenierung (ECMO) und Extrakorporales Life Support System (ECLS)
Klüß, Intensiv News 2012; 4:26-30

Extrakorporale Membran Oxygenierung (ECMO) und Extrakorporales Life Support System (ECLS) sind mittlerweile etablierte Standardverfahren an kardiochirurgischen Zentren. Die Betreuung der Geräte obliegt den Kardiotechnikern in enger Zusammenarbeit mit den behandelnden Ärzten. In universitären Krankenhäusern der Maximalversorgung erhalten die jeweiligen Fachabteilungen in der Regel ebenfalls von der kardiotechnischen Abteilung technische Unterstützung für den Einsatz dieser Systeme.

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Mild therapeutic hypothermia in cardiogenic shock syndrome
Zobel et al., Crit Care Med 2012; 40(6):1715-23

Zusammenfassung:

Objective: Mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest remains high despite advances in resuscitation and early revascularization strategies. Recent studies suggest a reduced mortality in survivors of cardiac arrest subjected to mild therapeutic hypothermia, but the underlying mechanisms are not yet clear. Because positive hemodynamic effects of mild therapeutic hypothermia have been suggested, we aimed at testing the hypothesis that patients in cardiogenic shock might benefit from mild therapeutic hypothermia.

Methods: Hemodynamic effects of mild therapeutic hypothermia in 20 consecutive patients admitted in cardiogenic shock after successful resuscitation from out-of-hospital cardiac arrest were investigated. A historic normothermic control group was matched (one-to-one) by means of a propensity score. Patients were cooled to 33°C for 24 hrs using an endovascular cooling device and hemodynamic variables were continuously recorded by means of pulse contour analysis. Cardiac performance was determined by echocardiography.

Results: Mild therapeutic hypothermia induced a significant decrease in heart rate from 74 to 64 beats per minute. Despite the reduction in heart rate, cardiac index remained unchanged under mild therapeutic hypothermia likely due to an increase in ejection fraction from 43 ± 4% to 55 ± 4%. Mean arterial pressure increased rapidly from 75 ± 2 mm Hg to 84 ± 3 mm Hg (p = .001) upon induction of hypothermia paralleled by an initial increase in systemic vascular resistance. Accordingly, patients with mild therapeutic hypothermia required lower cumulative doses of vasopressors and inotropes.

Conclusions: We conclude that in cardiogenic shock mild therapeutic hypothermia provides circulatory support and an increase in systemic vascular resistance that leads to reduced vasopressor use and may result in lower oxygen consumption. These findings suggest that mild therapeutic hypothermia could be a therapeutic option in hemodynamically unstable patients independent of cardiac arrest and further randomized clinical studies are needed.

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A pilot study comparing two polymethylpentene extracorporeal membrane oxygenators
Rambaud et al., Perfusion 2012, doi 10.1177/0267659112457970

Zusammenfassung:

Objective: We compared two polymethylpentene oxygenators being used in our unit: the Maquet Quadrox-iD paediatric® and the Medos Hilite 800LT®.

Study design: A mono-centric, prospective pilot study was conducted on ten consecutive newborn patients who had been admitted to our hospital service for extracorporeal circulation (EC) treatment. We examined the rate of oxygen transfer, the CO2 removal capacity and the average sweep gas flow required to produce this result. We also assessed the disturbances of haemostasis, the need for labile blood products and the membrane oxygenator lifetime and cost of use.

Conclusions: According to our study, it seems to us that Medos Hilite 800LT® membrane oxygenators demonstrate greater oxygen transfer and CO2 removal capacity than Maquet Quadrox-iD paediatric® membrane oxygenators, at a similar cost. These results lead us to conclude that it is reasonable to continue using Medos Hilite 800LT® membrane oxygenators. A broader comparison study would be necessary in order to support these initial results.

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Evaluation of two pediatric polymethyl pentene membrane oxygenators with pulsatile and non-pulsatile
Qiu et al., Perfusion 2011;26: 229

Zusammenfassung:

Objectives: This experiment sought to compare two polymethyl pentene (PMP) hollow-fiber membrane oxygenators: the Medos HILITE 2400 LT and the Maquet Quadrox-iD Pediatric in terms of transmembrane pressure gradients and hemodynamic energy preservation under both pulsatile and non-pulsatile conditions.

Methods: A simulated pediatric extracorporeal life support (ECLS) circuit was used to test these two oxygenators. The circuit consisted of a roller pump, ¼ inch tubing for both arterial and venous lines, an oxygenator, and a venous reservoir served as a pseudo-patient. Three pressure transducers were placed upstream and downstream of the oxygenator and the distal arterial line. The experimental system was primed with lactated Ringer’s solution and packed human red blood cells to maintain a hematocrit of 40%.The total volume was 600 ml, including the 350 ml volume of the pseudo-patient.The tests were performed at six flow rates (250, 500, 750, 1000, 1250, 1500 ml/min) and three distal arterial line pressures (MAP) (60, 80, 100 mmHg), under both pulsatile and non-pulsatile perfusion modes.The temperature was kept constant at 37°C for all tests.

Results: Both oxygenators had adequate performances in pressure drop and hemodynamic energy preservation. There were no significant differences between pre- and post-oxygenators for mean pressure (MP), energy equivalent pressure (EEP) and total hemodynamic energy (THE). During the pulsatile perfusion mode, the HILITE 2400 LT retained a greater percentage of surplus hemodynamic energy (SHE) across the oxygenator.

Conclusions: Both the Quadrox-iD Pediatric and HILITE 2400LT PMP membrane oxygenators are suitable for pediatric ECLS therapy under both non-pulsatile and pulsatile perfusion. An optimized combination of flow rate and MAP should be achieved in order to deliver the maximal pulsatile energy in the extracorporeal circuit.

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First uses of a new diagonal pump in extracorporeal support systems for children and infants
Tiedge & Optenhöfel, Kardiotechnik, 20th volume, 3rd book September 2011

Zusammenfassung:

Die Laufzeit pädiatrischer und neonataler ECMO-Einsätze hat sich in den vergangenen 25 Jahren mehr als verdoppelt. Möglich wurde dies vorrangig durch die technische Verbesserung der im ECMO System verwendeten Komponenten. Eine der neusten Entwicklungen ist die DELTASTREAM® DP3 Blutpumpe. Diese wurde im Rahmen der klinischen Erstanwendung zur Herz-Lungenunterstützung bei Kindern und Säuglingen getestet und wird aufgrund der überzeugenden Ergebnisse seitdem regelmäßig verwendet. Von Oktober 2009 – Mai 2011 wurde die Pumpe für 15 verschiedene extrakorporale Unterstützungen eingesetzt. Neben 14 ECMO-Einsätzen verwendeten wir die DP3 auch als pulsatil betriebenes LVAD über einen Zeitraum von 58 Tagen. Die neue Pumpe überzeugte mit hohen Standzeiten und niedrigen Hämolyseraten. Vor allem der optionale pulsatile Perfusionsmodus erweitert die Einsatzmöglichkeiten.  Mittlerweile wurde die DP3 in unserem Zentrum als Standardantrieb  extrakorporaler Unterstützungssysteme bei Kindern und Säuglingen etabliert.

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Quelle: Wang et al., Artificial Organs 2013


Quelle: Rambaud et al., Perfusion 2012


Quelle: Qiu et al., Perfusion 2011