Comparison of coronary artery blood flow and hemodynamic energy in a pulsatile pump versus a combined nonpulsatile pump and an intra-aortic balloon pump.

We compared the coronary artery blood flow and hemodynamic energy between pulsatile extracorporeal life support (ECLS) and a centrifugal pump (CP)/intra-aortic balloon pump (IABP) combination in cardiac arrest. A total cardiopulmonary bypass circuit was constructed for six Yorkshire swine weighing 30 to 40 kg. The outflow cannula of the CP or a pulsatile ECLS (T-PLS) was inserted into the ascending aorta, and the inflow cannula of the CP or T-PLS was placed into the right atrium. A 30-ml IABP was subsequently placed in the descending aorta. Extracorporeal circulation was maintained for 30 minutes with a pump flow of 75 ml/kg per minute by a CP with an IABP or T-PLS. Pressure and flow were measured in the right internal carotid artery. The energy equivalent pressure (EEP) and surplus plus hemodynamic energy (SHE) were recorded. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system. The percent change of the mean arterial pressure to EEP was effective in both groups (23.3 +/- 6.1 in CP plus IABP vs. 19.8 +/- 6.2% in T-PLS, p = NS). The SHE was high enough in the CP/IABP and the T-PLS (20,219.8 +/- 5824.7 vs. 13,160.2 +/- 4028.2 erg/cm3, respectively, p = NS). The difference in the coronary artery flow was not statistically significant at 30 minutes after bypass was initiated (28.2 +/- 9.79 ml/min in CP plus IABP vs. 27.7 +/- 9.35 ml/min in T-PLS, p = NS).