Use of a Novel Diagonal Pump in an In Vitro Neonatal Pulsatile Extracorporeal Life Support Circuit *Alissa Evenson, *Shigang Wang, †Allen R. Kunselman, and *‡§Akif Ündar *Pediatric Cardiovascular Research Center, Penn State Hershey Children’s Hospital, Penn State Milton S. Hershey Medical Center, Department of Pediatrics, Penn State Hershey College of Medicine; †Department of Public Health Sciences, Penn State Hershey College of Medicine; ‡Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Hershey, PA; and §Department of Bioengineering, College of Engineering, Pennsylvania State University, University Park, PA, USA Abstract: One approach with the potential to improve morbidity and mortality rates following extracorporeal life support (ECLS) is the use of pulsatile perfusion. Currently, no ECLS pumps used in the United States can produce pulsatile flow.The objective of this experiment is to evalu- ate a novel diagonal pump used in Europe to determine whether it provides physiological pulsatility in a neonatal model. The ECLS circuit consisted of a Medos Deltastream DP3 diagonal pump, a Hilite 800LT polymethylpentene diffusion membrane oxygenator, and arterial/venous tubing. A 300-mL pseudopatient was connected to the circuit using an 8Fr arterial cannula and a 10Fr venous cannula. A clamp maintained constant pressure entering the pseudopatient. Trials (64 total) were conducted in nonpulsatile and pulsatile modes at flow rates of 200 mL/ min to 800 mL/min. Flow and pressure data were collected using a custom-based data acquisition system. The Deltastream DP3 pump was capable of producing an adequate quality of pulsatility. Pulsatile flow produced increased mean arterial pressure, energy equivalent pres- sure (EEP), and surplus hemodynamic energy (SHE) at all flow rates compared to nonpulsatile flow. Pressure drop across the cannula accounted for the majority of pressure loss in the circuit. The greatest loss of SHE and total hemodynamic energy occurred across the arterial cannula due to its small diameter. The Deltastream DP3 pump pro- duced physiological pulsatile flow without backflow while providing EEP and SHE to our neonatal pseudopatient. Further experiments are necessary to determine the impact of this pulsatile pump in an in vivo model prior to clinical use. Key Words: Extracorporeal life support— Diagonal pump—Pediatrics—Pulsatile—Surplus hemody- namic energy. Extracorporeal life support (ECLS) is a life-saving technique that is used to provide support for patients with cardiac or respiratory disease. Over the past decade, there have been multiple technological advances in the components used during ECLS. Improvements have been made in the material used for the oxygenator, advancing from silicone mem- branes to microporous hollow-fiber membranes to the diffusion membranes that are the gold standard of oxygenators today.Additional improvements have been made to increase the efficiency of gas transfer across the membrane. Advances in the pumps used in the ECLS circuit have resulted in lower priming volumes and higher outputs for neonatal, pediatric, and adult patients. There have also been advances in the coating technique used in all circuit components to improve biocompatibility during long-term ECLS. These and other technological advances have resulted in improved survival rates in patients under- going ECLS. However, morbidity and mortality rates following ECLS remain unacceptably high, particu- larly in neonatal patients undergoing ECLS due to cardiac failure. According to the January 2013 Registry Report of the Extracorporeal Life Support Organization, 4987 neonatal patients (0–30 days old) were placed on ECLS from 1986 to 2012 due to cardiac failure at the 200 centers that submitted data for this report (1). Among this particular subset of patients, there was a staggering 60% mortality rate. Over the same period doi:10.1111/aor.12240 Received August 2013; revised September 2013. Address correspondence and reprint requests to Dr. Akif Ündar, Penn State Hershey College of Medicine, Department of Pediatrics—H085, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA. E-mail: aundar@psu.edu © 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation Artificial Organs 2014, 38(1):E1–E9