ALTERNATIVES TO ECMO FOR PEDIATRIC CIRCULATORY SUPPORT

ECMO 儿科循环支持的替代方案

• 批准号: 6527498
• 负责人: George M Pantalos
• 金额: $ 19.55万
• 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 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6527498
• 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）： 近年来，每年对新生儿和婴儿进行的外科手术 年稳步上升。随着越来越多的 程序的增加，需要提供临时 为这些病人提供循环支持当前常见的 实践是用体外膜支持这些患者 氧合电路（ECMO），即使支持的指示是 由于临床上无法获得循环系统， 适用于新生儿和婴儿患者的支撑装置 主动脉内球囊反搏（IABP）以外的人群。各种ECMO 据报道，四分之一到三分之一的使用 ECMO适用于仅需要心脏支持的病例。只有42% 这组患者的生存率最低， 所有类别的ECMO使用。为了改善儿童的结局， 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）。 新的数据还表明，IABP可能更有效地提供 搏动性左心室辅助（LVA）在儿科患者中的作用比 以前相信。 因此，婴儿VAD的预期可用性， 其中仅需要心脏支持是非常有吸引力的替代方案 到目前笨重、劳动密集型和昂贵的ECMO电路， 这通常与高并发症率有关。但如果 这些VAD是临床上可接受的，它们必须是，或更多， 比ECMO更有效 我们的假设是，新生儿和婴儿的脉动流LVA是 治疗上级ECMO。到目前为止，还没有系统的 评价ECMO与替代方案相比的生理有效性 使用临床相关生理参数测定婴儿LVA的方法。 实验使用急性制备的婴儿左心室动物模型， 将比较ECMO与CF和PF的疗效 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） 恢复终末器官灌注，3）减少心肌耗氧量， 和4）维持足够的混合静脉血氧饱和度。预期 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、心腔容积、氧饱和度和输送） 这将表明这些用于婴儿LVA的新器械具有上级 到ECMO，脉动流输送是最有效的治疗方法， 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LVA的儿科患者。