Evaluation and Comparison of Hemodynamic Performance of Three ECLS Systems in a Simulated Adult Cardiogenic Shock Model *†Akif € Undar , *Shigang Wang, *Morgan Moroi, ‡Allen R. Kunselman, and §Christoph E. Brehm *Department of Pediatrics, Penn State Health Pediatric Cardiovascular Research Center; †Department of Surgery and Bioengineering; ‡Department of Public Health and Sciences; and §Heart & Vascular Intensive Care Unit, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children’s Hospital, Hershey, PA, USA Abstract: The objective of this study was to evaluate three commercially available ECLS systems with rotary pumps in terms of circuit pressure, pressure drop, perfusion modes, and hemodynamic energy transmission in a simu- lated adult cardiogenic shock model. One circuit consisted of a Cardiohelp system, which included a Cardiohelp con- sole and HLS Module Advanced 7.0 tubing set with inte- grated centrifugal pump and oxygenator. The alternative circuit was composed of a Quadrox-D Adult oxygenator connected in series with either an i-cor diagonal pump and console or a Rotaflow centrifugal pump and console. The circuit was primed with lactated Ringer’s solution and packed red blood cells (hematocrit 40%). The trials were conducted at flow rates of 1-5 L/min with pseudo patient pressures of 60 mm Hg and 80 mm Hg. Pulsatile flow was tested when using the i-cor system. Mean pre-oxygenator pressure and pressure drop across ECLS circuit (including oxygenator and arterial tubing) were lower when using the Cardiohelp system as compared to the Rotaflow and i-cor systems (P < 0.01). The i-cor system was able to deliver more hemodynamic energy to the pseudo patient because of its ability to produce pulsatile flow (P < 0.01). The Car- diohelp HLS Module Advanced 7.0 integrated oxygenator had a lower resistance than the Quadrox-D oxygenator. Although the compact Cardiohelp system had a better hemodynamic performance when compared to Rotaflow and i-cor systems, the pulsatile flow of the i-cor system delivered more hemodynamic energy to the pseudo patient. This may render more physiological benefits in high-risk patients on ECLS. Key Words: Extracorporeal life support—Cardiogenic shock—Centrifugal pump— Diagonal pump—Pulsatile flow—Adult. In the past decade, the use of veno-arterial extra- corporeal membrane oxygenation (VA-ECMO) has grown rapidly by providing emergency mechanical pulmonary and circulatory assistance for patients with cardiogenic shock refractory to conventional medical therapies. The use of VA-ECMO will allow reduction and termination of vasopressors and inotropes after addressing and treating the underlying etiology. It can also be used as a bridge to a ventricular assist device (VAD) or cardiac transplantation, and it may be conveniently placed at the catheterization laboratory, the intensive care unit, the emergency department, or the operating room. Recently, significant technological advances have led to improved VA-ECMO survival and reduced complications (1–3). However, according to the July 2017 Extracorporeal Life Support Organization (ELSO) Registry Report, the survival-to-hospital discharge rate in adult patients with cardiogenic shock on ECMO is only 42% (4). The morbidity and mortality rates increase with ECMO duration. Complications involving the vital doi: 10.1111/aor.13126 Received October 2017; revised January 2018; accepted January 2018. Address correspondence reprint requests to Akif € Undar, PhD Professor of Pediatrics, Surgery, and Bioengineering, Penn State College of Medicine, Department of Pediatrics - H085, 500 University Drive, P.O. Box 850; Hershey, PA 17033-0850, USA. E-mail: aundar@psu.edu Artificial Organs 2018, 42(8):776–785 V C 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.