Hemodynamic guidelines for design and control of a turbodynamic pediatric ventricular assist device.

The design of mechanical circulatory support devices typically requires a priori knowledge of the hemodynamic requirements of their intended use. These requirements are difficult to determine because of limited clinical experience. This is especially true for the pediatric population, for whom there is a dearth of longitudinal data. This report aims to provide both engineers and physicians with benchmarks for determining the optimal flow requirements and settings for pediatric ventricular assist devices that are currently being developed. Criteria were developed on the basis of estimates derived from various sources. The potential patient population was estimated by using the prevalence of children on the heart transplant waiting list and those placed on extracorporeal membrane oxygenation. Cardiac outputs were determined for individual weights and body surface areas, using published values for healthy and sick pediatric patients. The recommended pump range was optimized to include the most patients, while considering the design constraints. This study identifies a significant population of patients who would benefit from a device providing 0.52 to 1.92 l/min.

[1]  E. Jokinen,et al.  Left atrial and left ventricular function in healthy children and young adults assessed by three dimensional echocardiography , 2003, Heart.

[2]  P. Y. Wu,et al.  Pulsed Doppler determinations of cardiac output in neonates: normal standards for clinical use. , 1985, Pediatrics.

[3]  P. Rycus,et al.  Extracorporeal Life Support Registry Report 2004 , 2005, ASAIO journal.

[4]  Paul S Agutter,et al.  Metabolic scaling: consensus or controversy? , 2004, Theoretical Biology and Medical Modelling.

[5]  Michael J. Reiss,et al.  The allometry of growth and reproduction , 1989 .

[6]  T. Vogl,et al.  Erstellung von Referenzwerten für die MRT-basierte Flussmessung im Truncus pulmonalis bei gesunden Kindern und Jugendlichen , 2004 .

[7]  J F Antaki,et al.  Fluid dynamic characterization of operating conditions for continuous flow blood pumps. , 1999, ASAIO journal.

[8]  Harry C. Shirkey,et al.  Pediatric Dosage Handbook , 1980 .

[9]  J. Parker,et al.  Hemodynamics at rest and during supine and sitting bicycle exercise in normal subjects. , 1978, The American journal of cardiology.

[10]  R. Sorelle.  United Network for Organ Sharing. , 1997, Circulation.

[11]  U. Fakler,et al.  Cardiac output determination in children: equivalence of the transpulmonary thermodilution method to the direct Fick principle , 2002, Intensive Care Medicine.

[12]  J. Frassica,et al.  Pediatric Dosage Handbook, 6th Edition , 2000 .

[13]  G. Dudell,et al.  A comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure. , 1996, Critical care medicine.

[14]  Harvey S Borovetz,et al.  The National Heart, Lung, and Blood Institute Pediatric Circulatory Support Program. , 2005, Circulation.

[15]  P. Walser,et al.  Normal Values for Pulmonary Hemodynamics at Rest and during Exercise in Man , 1975 .

[16]  Paul E. Allaire,et al.  Pediatric Circulatory Support Systems , 2002, ASAIO journal.

[17]  S. Daniels,et al.  Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. , 1997, Circulation.

[18]  A Sidiropoulos,et al.  Pediatric circulatory support. , 1998, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[19]  T. Kusaka,et al.  Cerebral distribution of cardiac output in newborn infants , 2004, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[20]  L. Cook.  Update on extracorporeal membrane oxygenation. , 2004, Paediatric respiratory reviews.