Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems

Shigang Wang, Conrad Krawiec, Sunil Patel, Allen Kunselman, Jianxun Song, Fengyang Lei, Larry D. Baer, Akif Undar

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12h at a flow rate of 500mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean±standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6±253.1mg/L, DP3-NP group: 343.7±163.2mg/L, and DP3-P group: 407.6±156.6mg/L, P=0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P>0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P<0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.

Original languageEnglish (US)
Pages (from-to)774-781
Number of pages8
JournalArtificial Organs
Volume39
Issue number9
DOIs
StatePublished - Jan 1 2015

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Life Support Systems
Extracorporeal Membrane Oxygenation
Hemolysis
Pumps
Pulsatile Flow
Pulsatile flow
Hemodynamics
Blood
Oxygenators
Networks (circuits)
Hemoglobin
Hemoglobins
Plasmas
Interleukin-8
L-Lactate Dehydrogenase
Clamping devices
Lactic acid
Lactic Acid
Interleukin-6
Electron energy levels

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

Cite this

@article{8f03587f153644749ada38a20aaeff03,
title = "Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems",
abstract = "The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12h at a flow rate of 500mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean±standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6±253.1mg/L, DP3-NP group: 343.7±163.2mg/L, and DP3-P group: 407.6±156.6mg/L, P=0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P>0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P<0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.",
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Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems. / Wang, Shigang; Krawiec, Conrad; Patel, Sunil; Kunselman, Allen; Song, Jianxun; Lei, Fengyang; Baer, Larry D.; Undar, Akif.

In: Artificial Organs, Vol. 39, No. 9, 01.01.2015, p. 774-781.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Laboratory Evaluation of Hemolysis and Systemic Inflammatory Response in Neonatal Nonpulsatile and Pulsatile Extracorporeal Life Support Systems

AU - Wang, Shigang

AU - Krawiec, Conrad

AU - Patel, Sunil

AU - Kunselman, Allen

AU - Song, Jianxun

AU - Lei, Fengyang

AU - Baer, Larry D.

AU - Undar, Akif

PY - 2015/1/1

Y1 - 2015/1/1

N2 - The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12h at a flow rate of 500mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean±standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6±253.1mg/L, DP3-NP group: 343.7±163.2mg/L, and DP3-P group: 407.6±156.6mg/L, P=0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P>0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P<0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.

AB - The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics of a conventional roller pump (HL20-NP) and an alternative diagonal pump with nonpulsatile (DP3-NP) and pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. The experimental neonatal ECLS circuits consist of a conventional Jostra HL20 roller pump or an alternative Medos DP3 diagonal pump, and Medos Hilite 800 LT hollow-fiber oxygenator with diffusion membrane. Eighteen sterile circuits were primed with freshly donated whole blood and divided into three groups: conventional HL20 with nonpulsatile flow (HL20-NP), DP3 with nonpulsatile flow (DP3-NP), and DP3 with pulsatile flow (DP3-P). All trials were conducted for durations of 12h at a flow rate of 500mL/min at 36°C. Simultaneous blood flow and pressure waveforms were recorded. Blood samples were collected to measure plasma-free hemoglobin (PFH), human tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-8, in addition to the routine blood gas, lactate dehydrogenase, and lactic acid levels. HL20-NP group had the highest PFH levels (mean±standard error of the mean) after a 12-h ECLS run, but the difference among groups did not reach statistical significance (HL20-NP group: 907.6±253.1mg/L, DP3-NP group: 343.7±163.2mg/L, and DP3-P group: 407.6±156.6mg/L, P=0.06). Although there were similar trends but no statistical differences for the levels of proinflammatory cytokines among the three groups, the HL20-NP group had much greater levels than the other groups (P>0.05). Pulsatile flow generated higher total hemodynamic energy and surplus hemodynamic energy levels at pre-oxygenator and pre-clamp sites (P<0.01). Our study demonstrated that the alternative diagonal pump ECLS circuits appeared to have less systemic inflammatory response and hemolysis compared with the conventional roller pump ECLS circuit in simulated neonatal ECLS systems. Pulsatile flow delivered more hemodynamic energy to the pseudo-patient without increased odds of hemolysis compared with the conventional, nonpulsatile roller pump group.

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