Effects of Pulsatile Blood Flow on Oxygenator Performance
Effects of Pulsatile Blood Flow on Oxygenator Performance
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DOI：
10.1111/aor.13088
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发表时间：
2018-04-01
影响因子：
2.4
通讯作者：
Arens, Jutta
中科院分区：
文献类型：
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作者：
Schraven, Lotte;Kaesler, Andreas;Arens, Jutta
体外膜肺氧合（ECMO）主要用于治疗急性呼吸窘迫综合征和慢性阻塞性肺疾病。在过去的几年中，这些系统的开发在优化方面取得了巨大的进步，但仍然存在血栓形成、堵塞以及气体交换不足的问题。ECMO优化的一个想法是通过氧合器的脉动血流，但这仍然是一个有争议的讨论。分析现有出版物，无法确定脉动血流对气体交换性能影响的一般性声明。参数和电路元件的多样性对结果有很大的影响，因此很难对研究结果进行直接比较。为此，我们进行了一项结构化研究，以评估脉动血流对氧合器气体交换性能的影响。在根据DIN EN ISO 7199进行的体外试验中，我们测试了小型氧合器（0.25 m（2）交换表面，聚甲基戊烯纤维，33 mL预充体积），并与恒定和脉动血流进行比较。因此，我们将平均血流量从250 mL/min变化到1200 mL/min，振幅为0、20和50%，频率为30、60和90 bpm。结果表明，对于相同的平均血流范围，脉动和恒定血流的气体转移相似（氧气：36-64 mL（O2）/L-血液;二氧化碳35-80 mL（CO2）/L-血液）。总的来说，结果和分析表明，脉动流和非脉动流之间的统计学差异不显著。因此，我们得出结论，脉动血流的实施对氧合器中的气体交换性能只有很小的影响或没有影响。由于结果是使用带有盘绕纤维束的氧合器获得的，因此必须验证堆叠纤维氧合器的测试。
Extracorporeal membrane oxygenation (ECMO) is mainly used for the therapy of acute respiratory distress syndrome and chronic obstructive lung disease. In the last years, the development of these systems underwent huge steps in optimization, but there are still problems with thrombus formation, clogging, and thus insufficient gas exchange. One idea of ECMO optimization is a pulsatile blood flow through the oxygenator, but this is still a controversy discussion. Analyzing available publications, it was not possible to identify a general statement about the effect of pulsatile blood flow on the gas exchange performance. The variety of parameters and circuit components have such a high influence on the outcome that a direct comparison of the studies is difficult. For this reason, we performed a structured study to evaluate the effects of pulsatile blood flow on the gas exchange performance of oxygenator. In in vitro tests according to DIN EN ISO 7199, we tested a small oxygenator (0.25 m(2) exchange surface, polymethylpentene fibers, 33 mL priming volume) with constant and pulsatile blood flow in comparison. Therefore, we varied the mean blood flow from 250 to 1200 mL/min, the amplitude of 0, 20, and 50%, and the frequency of 30, 60, and 90 bpm. The results demonstrate that the gas transfer for pulsatile and constant blood flow was similar (oxygen: 36-64 mL(O2)/L-Blood; carbon dioxide 35-80 mL(CO2)/L-Blood) for the same mean blood flow ranges. Over all, the results and analyses showed a statistically nonsignificant difference between pulsatile and nonpulsatile flow. Consequently, we conclude that the implementation of pulsatile blood flow has only a small to no effect on the gas exchange performance in an oxygenator. As the results were obtained using an oxygenator with a coiled fiber bundle, the test must be verified for a stacked fiber oxygenator.