ALTERNATIVES TO ECMO FOR PEDIATRIC CIRCULATORY SUPPORT

ECMO 儿科循环支持的替代方案

• 批准号: 6151382
• 负责人: George M Pantalos
• 金额: $ 13.5万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 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 2003-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6151382
• 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：(改编自申请者摘要)：心脏数量 近年来每年对新生儿和婴儿进行的外科手术 年数稳步增加。与数量不断增加的 程序已经增加，需要提供临时 为其中一些患者提供循环支持。一种当前的普遍现象 实践是用体外膜支持这些患者。 氧合回路(ECMO)，即使支持的迹象是 纯心脏，由于临床上无法使用循环系统 适用于新生儿和婴儿患者的支持装置 除主动脉内气囊反搏(IABP)外的其他人群。各种ECMO 项目报告说，他们使用的四分之一到三分之一的 ECMO适用于仅需要心脏支持的情况。只有42% 这组患者的存活率是最低的 适用于所有类别的ECMO使用。为改善儿科疾病的预后 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脑室辅助装置(VAD)。 新的数据还表明，IABP可能更有效地提供 搏动性左心辅助(LVA)在儿童患者中的应用 之前人们认为。 因此，预期可用于病例的婴儿VAD 在只需要心脏支持的情况下是一个非常有吸引力的选择 到目前繁琐、劳动密集型和昂贵的ECMO电路 这通常与较高的并发症发生率有关。但是，如果 这些VAD要在临床上被接受，它们必须是，或更多， 比体外循环法更有效。 我们的假设是新生儿和婴儿的搏动性血流LVA是 在治疗上优于ECMO。到目前为止，还没有系统的 体外反搏与替代方案的生理疗效比较 方法采用临床相关生理参数进行婴幼儿LVA检查。 使用精心准备的左脑幼年动物模型进行实验 心功能不全将ECMO与CF和PF的疗效进行比较 通过确定每个设备和IABP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) 恢复终末器官灌流，3)降低心肌耗氧量， (4)维持充分的混合静脉血氧饱和度。预期中的 这项研究的结果将是临床相关的生理数据 (血压和血流量、组织灌注量、心肌氧含量 消耗、心腔容量、血氧饱和度和输出量) 这将表明这些用于婴儿LVA的新设备是优越的 对于ECMO，脉冲式血流输送是最具治疗性的 有效的方法。这一新信息将导致 考虑ECMO的替代方案，以改善 需要肺泡灌洗的儿科患者。