Effect of the Pulsatile Extracorporeal Membrane Oxygenation on Hemodynamic Energy and Systemic Microcirculation in a Piglet Model of Acute Cardiac Failure

  • Itoh H
  • Ichiba S
  • Ujike Y
 et al. 
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The objective of this study was to compare the effects of pulsatile and
nonpulsatile extracorporeal membrane oxygenation (ECMO) on hemodynamic
energy and systemic microcirculation in an acute cardiac failure model
in piglets. Fourteen piglets with a mean body weight of 6.08 +/- 0.86 kg
were divided into pulsatile (N = 7) and nonpulsatile (N = 7) ECMO
groups. The experimental ECMO circuit consisted of a centrifugal pump, a
membrane oxygenator, and a pneumatic pulsatile flow generator system
developed in-house. Nonpulsatile ECMO was initiated at a flow rate of
140 mL/kg/min for the first 30 min with normal heart beating, with
rectal temperature maintained at 36 degrees C. Ventricular fibrillation
was then induced with a 3.5-V alternating current to generate a cardiac
dysfunction model. Using this model, we collected the data on pulsatile
and nonpulsatile groups. The piglets were weaned off ECMO at the end of
the experiment (180 min after ECMO was initiated). The animals did not
receive blood transfusions, inotropic drugs, or vasoactive drugs. Blood
samples were collected to measure hemoglobin, methemoglobin, blood
gases, electrolytes, and lactic acid levels. Hemodynamic energy was
calculated using the Shepard's energy equivalent pressure. Near-infrared
spectroscopy was used to monitor brain and kidney perfusion. The
pulsatile ECMO group had a higher atrial pressure (systolic and mean),
and significantly higher regional saturation at the brain level, than
the nonpulsatile group (for both, P < 0.05). Additionally, the pulsatile
ECMO group had higher methemoglobin levels within the normal range than
the nonpulsatile group. Our study demonstrated that pulsatile ECMO
produces significantly higher hemodynamic energy and improves systemic
microcirculation, compared with nonpulsatile ECMO in acute cardiac

Author-supplied keywords

  • Extracorporeal membrane oxygenation
  • Hemodynamic energy
  • Pediatric
  • Pulsatile
  • Systemic microcirculation

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  • Hideshi Itoh

  • Shingo Ichiba

  • Yoshihito Ujike

  • Takuma Douguchi

  • Hideaki Obata

  • Syuji Inamori

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