Optimizing the circuit of a pulsatile extracorporeal life support system in terms of energy equivalent pressure and surplus hemodynamic energy

The nonpulsatile blood flow obtained using standard cardiopulmonary bypass (CPB) circuits is still generally considered an acceptable, nonphysiologic compromise with few disadvantages. However, numerous reports have concluded that pulsatile perfusion during CPB achieves better multiorgan response postoperatively. Furthermore, pulsatile flow during CPB has been consistently recommended in pediatric and high-risk patients. However, most (80%) of the total hemodynamic energy generated by a pulsatile pump is absorbed by the components of the extracorporeal circuit and only a small portion of the pulsatile energy is delivered to the patient. Therefore, we considered that optimizations of CPB unit and extracorporeal life support (ECLS) system circuit components were needed to deliver sufficient pulsatile flow. In addition, energy equivalent pressure, surplus hemodynamic energy, and total hemodynamic energy, calculated using pressure and flow waveforms, were used to evaluate the pulsatilities of pulsatile CPB and ECLS systems.