ALTERNATIVES TO ECMO FOR PEDIATRIC CIRCULATORY SUPPORT

ECMO 儿科循环支持的替代方案

• 批准号: 2742072
• 负责人: George M Pantalos
• 金额: $ 7.5万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-02-15 至 2000-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2742072
• 关键词: aortic balloon pump; biomedical equipment development; blood circulation; blood pressure; circulatory assist; disease /disorder model; extracorporeal circulation; heart disorder; heart surgery; heart ventricle; hemodynamics; infant animal; intracardiac volume; mitral valve; newborn animals; oxygen consumption; oxygen transport; swine

DESCRIPTION: (Adapted from Applicant's Abstract): The number of cardiac surgical procedures performed annually on neonates and infants in recent years has steadily increased. Corresponding to the increasing number of procedures has been the increase in the need to provide temporary circulatory support for some of these patients. A current common practice is to support these patients with extracorporeal membrane oxygenation circuitry (ECMO), even when the indications for support are purely cardiac, due to the clinical unavailability of circulatory support devices appropriate for the neonatal and infant patient populations other than the intraaortic balloon pump (IABP). Various ECMO programs report that between one-fourth to one-third of their use of ECMO is for cases where solely cardiac support was required. Only a 42% survival rate has been achieved in this group of patients, the lowest for all categories of ECMO use. To improve the outcome of pediatric patients requiring circulatory support, efforts are being made to develop reliable continuous flow (CF) and pulsatile flow (PF) ventricular assist devices (VADs) appropriate for neonates and infants. New data also suggest that the IABP may be more effective in providing pulsatile left ventricular assistance (LVA) in pediatric patients than previously believed. Consequently, the anticipated availability of an infant VAD for cases where only cardiac support is required is a very attractive alternative to the current cumbersome, labor-intensive, and expensive ECMO circuitry that is often associated with a high complication rate. However, if these VADs are to be clinically acceptable, they must be as, or more, efficacious than ECMO. Our hypothesis is that pulsatile flow LVA in neonates and infants is therapeutically superior to ECMO. To date there has been no systematic evaluation of the physiologic efficacy of ECMO compared to alternative methods for infant LVA using clinically relevant physiologic parameters. Experiments using an acutely prepared, infant animal model of left ventricular dysfunction will compare the efficacy of ECMO to CF and PF assist devices and the IABP by determining the ability of each assistance technique to: 1) restore an acceptable hemodynamic state, 2) restore end-organ perfusion, 3) reduce myocardial oxygen consumption, and 4) maintain adequate mixed venous oxygen saturation. The anticipated result of this research will be clinically relevant physiologic data (blood pressures and flows, tissue perfusion, myocardial oxygen consumption, cardiac chamber volumes, oxygen saturation and delivery) that will indicate that these new devices for infant LVA are superior to ECMO, with pulsatile flow delivery being the most therapeutically effective approach. This new information will result in the consideration of alternatives to ECMO to improve the outcome of pediatric patients requiring LVA.

描述：（改编自申请人的摘要）：心脏的数量 近年来每年对新生儿和婴儿进行的外科手术 年稳步增长。对应数量的不断增加 程序已增加，需要提供临时 为其中一些患者提供循环支持。目前常见的一个 做法是用体外膜来支持这些患者 氧合电路 (ECMO)，即使支持指示是 由于临床上缺乏循环系统，纯粹是心脏疾病 适用于新生儿和婴儿患者的支持装置 主动脉内球囊反搏器 (IABP) 以外的人群。各种ECMO 计划报告说，四分之一到三分之一的人使用 ECMO 适用于仅需要心脏支持的情况。只有42% 本组患者的生存率是最低的 适用于所有类别的 ECMO 使用。改善儿科治疗结果 需要循环支持的患者，正在努力 开发可靠的连续流 (CF) 和脉动流 (PF) 适用于新生儿和婴儿的心室辅助装置 (VAD)。 新数据还表明，IABP 可能更有效地提供 儿科患者的脉动左心室辅助 (LVA) 优于 以前相信。 因此，婴儿 VAD 的预期可用性 仅需要心脏支持的情况是一个非常有吸引力的替代方案 当前笨重、劳动密集型且昂贵的 ECMO 电路 这通常与高并发症发生率相关。然而，如果 这些 VAD 必须是临床可接受的，它们必须是或更多， 比ECMO有效。 我们的假设是，新生儿和婴儿的脉动血流 LVA 是 治疗效果优于ECMO。迄今为止还没有系统的 ECMO 与替代方案相比的生理功效评估 使用临床相关生理参数进行婴儿 LVA 的方法。 使用精心准备的左侧婴儿动物模型进行实验 心室功能不全将比较ECMO对CF和PF的疗效 通过确定每个设备的能力来辅助设备和 IABP 辅助技术：1) 恢复可接受的血流动力学状态，2) 恢复终末器官灌注，3）减少心肌耗氧量， 4) 维持足够的混合静脉血氧饱和度。预计的 这项研究的结果将是临床相关的生理数据 （血压和流量、组织灌注、心肌氧 消耗、心室容积、氧饱和度和输送） 这表明这些用于婴儿 LVA 的新设备是优越的 ECMO，脉动血流输送是最具治疗效果的 有效的方法。这一新信息将导致 考虑 ECMO 替代方案以改善治疗结果 需要 LVA 的儿科患者。