体外膜氧合(ECMO)氧合器分流流对新生儿溶血影响的评价:一项体外研究。

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Perfusion-Uk Pub Date : 2025-10-01 Epub Date: 2025-02-17 DOI:10.1177/02676591251322000
Christopher Nemeh, Caleb Varner, Nicholas Schmoke, Elon Trager, Yeu Sanz Wu, Michael Brewer, Caitlin Cain-Trivette, Nikki Aw, Richard O Francis, Diana Vargas Chaves, Eva W Cheung, William Middlesworth
{"title":"体外膜氧合(ECMO)氧合器分流流对新生儿溶血影响的评价:一项体外研究。","authors":"Christopher Nemeh, Caleb Varner, Nicholas Schmoke, Elon Trager, Yeu Sanz Wu, Michael Brewer, Caitlin Cain-Trivette, Nikki Aw, Richard O Francis, Diana Vargas Chaves, Eva W Cheung, William Middlesworth","doi":"10.1177/02676591251322000","DOIUrl":null,"url":null,"abstract":"<p><p>IntroductionExtracorporeal membrane oxygenation (ECMO) is utilized in critically ill neonates with severe cardiopulmonary failure. Hemolysis is a potential complication and is associated with significantly increased morbidity and mortality. The etiology of hemolysis in neonates is multifactorial, including shear forces generated by the ECMO pump, higher flow resistance from smaller tubing and smaller cannulas, the oxygenator, and other patient factors. Centrifugal pumps and oxygenators commonly have shunts with partially occluding clamps to regulate blood flow. We hypothesized that these clamps are significant contributors to hemolysis.MethodAn in vitro study was conducted with three identical ECMO circuits containing an integrated polymethylpentene (PMP) oxygenator and centrifugal pump (Cardiohelp HLS 5.0) and 1/4″ arteriovenous (AV) loop tubing. The circuits were primed with equal components, including expired ABO-compatible packed red blood cells (pRBCs), 25% albumin, 5% albumin, sodium bicarbonate, heparin, and calcium chloride. Circuit A had a completely occluded shunt. Circuit B had a partially occluded shunt, allowing 500 mL/min of shunt flow back to the oxygenator. Circuit C had a fully open shunt, generating 1000 mL/min of shunt flow back to the oxygenator. Plasma-free hemoglobin values were measured serially over 5 days.ResultsBaseline plasma-free hemoglobin levels were equal in all three circuits. Circuit C had the greatest increase in plasma-free hemoglobin daily (26.3 mg/dL/day) compared to Circuit A and Circuit B, which were 14.1 mg/dL/day and 12.9 mg/dL/day, respectively.ConclusionsOur data suggests that partially occluding clamps are not a significant contributor to hemolysis; rather, increased flow through the oxygenator significantly increased the rate of hemolysis in neonatal ECMO circuits.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"1646-1652"},"PeriodicalIF":1.1000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of the impact of extracorporeal membrane oxygenation (ECMO) oxygenator shunt flow on neonatal hemolysis: An in vitro study.\",\"authors\":\"Christopher Nemeh, Caleb Varner, Nicholas Schmoke, Elon Trager, Yeu Sanz Wu, Michael Brewer, Caitlin Cain-Trivette, Nikki Aw, Richard O Francis, Diana Vargas Chaves, Eva W Cheung, William Middlesworth\",\"doi\":\"10.1177/02676591251322000\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>IntroductionExtracorporeal membrane oxygenation (ECMO) is utilized in critically ill neonates with severe cardiopulmonary failure. Hemolysis is a potential complication and is associated with significantly increased morbidity and mortality. The etiology of hemolysis in neonates is multifactorial, including shear forces generated by the ECMO pump, higher flow resistance from smaller tubing and smaller cannulas, the oxygenator, and other patient factors. Centrifugal pumps and oxygenators commonly have shunts with partially occluding clamps to regulate blood flow. We hypothesized that these clamps are significant contributors to hemolysis.MethodAn in vitro study was conducted with three identical ECMO circuits containing an integrated polymethylpentene (PMP) oxygenator and centrifugal pump (Cardiohelp HLS 5.0) and 1/4″ arteriovenous (AV) loop tubing. The circuits were primed with equal components, including expired ABO-compatible packed red blood cells (pRBCs), 25% albumin, 5% albumin, sodium bicarbonate, heparin, and calcium chloride. Circuit A had a completely occluded shunt. Circuit B had a partially occluded shunt, allowing 500 mL/min of shunt flow back to the oxygenator. Circuit C had a fully open shunt, generating 1000 mL/min of shunt flow back to the oxygenator. Plasma-free hemoglobin values were measured serially over 5 days.ResultsBaseline plasma-free hemoglobin levels were equal in all three circuits. Circuit C had the greatest increase in plasma-free hemoglobin daily (26.3 mg/dL/day) compared to Circuit A and Circuit B, which were 14.1 mg/dL/day and 12.9 mg/dL/day, respectively.ConclusionsOur data suggests that partially occluding clamps are not a significant contributor to hemolysis; rather, increased flow through the oxygenator significantly increased the rate of hemolysis in neonatal ECMO circuits.</p>\",\"PeriodicalId\":49707,\"journal\":{\"name\":\"Perfusion-Uk\",\"volume\":\" \",\"pages\":\"1646-1652\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Perfusion-Uk\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/02676591251322000\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perfusion-Uk","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/02676591251322000","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/17 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

简介:体外膜氧合(ECMO)应用于危重新生儿重症心肺衰竭。溶血是一种潜在的并发症,与显著增加的发病率和死亡率相关。新生儿溶血的病因是多因素的,包括ECMO泵产生的剪切力,更小的管道和更小的套管产生的更高的流动阻力,氧合器和其他患者因素。离心泵和氧合器通常有分流部分闭塞钳调节血液流动。我们假设这些夹子是溶血的重要贡献者。方法:采用三种相同的ECMO回路进行体外研究,该回路包含一个集成的聚甲基戊烯(PMP)氧合器和离心泵(Cardiohelp HLS 5.0)和1/4″动静脉(AV)环管。回路中注入相同成分,包括过期abo相容的填充红细胞(prbc)、25%白蛋白、5%白蛋白、碳酸氢钠、肝素和氯化钙。A路有一个完全闭塞的分流。回路B有一个部分闭塞的分流,允许500 mL/min的分流回流到氧合器。电路C有一个全开分流,产生1000 mL/min的分流回流到氧合器。在5天内连续测量无血浆血红蛋白值。结果:三个回路的基线血浆游离血红蛋白水平相等。与回路A和回路B相比,回路C每天的无血浆血红蛋白增加最多(26.3 mg/dL/day),回路A和回路B分别为14.1 mg/dL/day和12.9 mg/dL/day。结论:我们的数据表明,部分闭塞钳不是溶血的重要因素;相反,通过氧合器的流量增加显著增加了新生儿ECMO回路中的溶血率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of the impact of extracorporeal membrane oxygenation (ECMO) oxygenator shunt flow on neonatal hemolysis: An in vitro study.

IntroductionExtracorporeal membrane oxygenation (ECMO) is utilized in critically ill neonates with severe cardiopulmonary failure. Hemolysis is a potential complication and is associated with significantly increased morbidity and mortality. The etiology of hemolysis in neonates is multifactorial, including shear forces generated by the ECMO pump, higher flow resistance from smaller tubing and smaller cannulas, the oxygenator, and other patient factors. Centrifugal pumps and oxygenators commonly have shunts with partially occluding clamps to regulate blood flow. We hypothesized that these clamps are significant contributors to hemolysis.MethodAn in vitro study was conducted with three identical ECMO circuits containing an integrated polymethylpentene (PMP) oxygenator and centrifugal pump (Cardiohelp HLS 5.0) and 1/4″ arteriovenous (AV) loop tubing. The circuits were primed with equal components, including expired ABO-compatible packed red blood cells (pRBCs), 25% albumin, 5% albumin, sodium bicarbonate, heparin, and calcium chloride. Circuit A had a completely occluded shunt. Circuit B had a partially occluded shunt, allowing 500 mL/min of shunt flow back to the oxygenator. Circuit C had a fully open shunt, generating 1000 mL/min of shunt flow back to the oxygenator. Plasma-free hemoglobin values were measured serially over 5 days.ResultsBaseline plasma-free hemoglobin levels were equal in all three circuits. Circuit C had the greatest increase in plasma-free hemoglobin daily (26.3 mg/dL/day) compared to Circuit A and Circuit B, which were 14.1 mg/dL/day and 12.9 mg/dL/day, respectively.ConclusionsOur data suggests that partially occluding clamps are not a significant contributor to hemolysis; rather, increased flow through the oxygenator significantly increased the rate of hemolysis in neonatal ECMO circuits.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Perfusion-Uk
Perfusion-Uk 医学-外周血管病
CiteScore
3.00
自引率
8.30%
发文量
203
审稿时长
6-12 weeks
期刊介绍: Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信