Benefits of Pulsatile Perfusion on Vital Organ Recovery During and After Pediatric Open Heart Surgery

Alkan, Tijen; Akçevin, Atf; Ündar, Akif; Türkoğlu, Halil; Paker, Tufan; Aytaç, Aydın

doi:10.1097/mat.0b013e31814fb506

Cited by 63 publications

(60 citation statements)

References 9 publications

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“…Perfusion mode (pulsatile or nonpulsatile), flow rate, temperature, as well as different types of blood pumps and oxygenator designs also influence embolic load delivered to the patient (7–9). Studies suggest distinct advantages of pulsatile perfusion during cardiopulmonary bypass on organ perfusion and postoperative recovery (10–12). As such, the present study analyzed the respective neonatal oxygenators under both nonpulsatile and pulsatile modes.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Neonatal Membrane Oxygenators With Respect to Gaseous Microemboli Capture and Transmembrane Pressure Gradients

Qiu

Guan

et al. 2010

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A series of studies performed at our center demonstrates that gaseous microemboli (GME) remain a challenge in cardiac surgical procedures. Evaluation of novel oxygenators must address hemodynamic parameters and microemboli capture capability. The objective of this study is to compare two neonatal membrane oxygenators, the Quadrox-i (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) and the Capiox RX05 (Terumo Corporation, Tokyo, Japan), with respect to GME capture and hemodynamic energy delivery. The experimental circuit included a Maquet HL-20 heart-lung machine, a Heater-Cooler Unit HCU 30 (MAQUET Cardiopulmonary AG), a membrane oxygenator (Quadrox-i Neonatal or Capiox RX05), and ¼-inch tubing from the COBE Heart/Lung Perfusion Pack (COBE Cardiovascular, Inc., Arvada, CO, USA). A Capiox cardiotomy reservoir CX*CR10NX (Terumo Corporation) acted as a pseudopatient. The circuit was primed with human packed red blood cells and lactated Ringer's solution and de-aired according to clinical priming procedure. Heparin (5000IU) was added into the circuit. The total volume was 400mL and hematocrit was 30%. Pump flow rate was maintained at 500 or 1000mL/min under both pulsatile and nonpulsatile modes. All trials were conducted under 100mm Hg of circuit pressure at normothermia (35°C). In each trial, bolus air (0.5mL) was injected into the circuit at the prepump site over 5s. Total emboli counts and total emboli volume were significantly reduced by the Quadrox-i Neonatal membrane oxygenator compared to the Capiox RX05 membrane oxygenator. Classification and quantification of GME detected at the postoxygenator site at two different flow rates indicated that the Quadrox-i Neonatal captures the majority of microemboli larger than 40µm in diameter. The Quadrox-i Neonatal membrane oxygenator had a higher transmembrane pressure drop at 500mL/min, whereas it had a lower pressure drop at 1000mL/min compared to the Capiox Baby RX05 oxygenator. Additionally, the Quadrox-i Neonatal oxygenator preserved more pulsatile energy than the Baby RX05 oxygenator at both flow rates. Compared to the Capiox RX05 membrane oxygenator, the Quadrox-i Neonatal membrane oxygenator has significantly improved GME handling capacity and had better hemodynamic energy preservation. Further research encompassing in vivo and clinical studies is needed to investigate the magnitude and mechanisms of these benefits.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Neonatal Membrane Oxygenators With Respect to Gaseous Microemboli Capture and Transmembrane Pressure Gradients

Qiu

Guan

et al. 2010

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“…Thus, patients receiving pulsatile perfusion benefited with improved cardiac, renal, and pulmonary function following CPB. Additional experiments have confirmed and elaborated on these results in favor of pulsatile perfusion (5–9). With this recent focus on the benefits of pulsatile perfusion, ensuring that each component does not detract from these benefits is a must.…”

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Comparison of Two Types of Neonatal Extracorporeal Life Support Systems With Pulsatile and Nonpulsatile Flow

et al. 2009

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We compared the effects of two neonatal extracorporeal life support (ECLS) systems on circuit pressures and surplus hemodynamic energy levels in a simulated ECLS model. The clinical set-up included the Jostra HL-20 heart-lung machine, either the Medtronic ECMO (0800) or the MEDOS 800LT systems with company-provided circuit components, a 10 Fr arterial cannula, and a pseudo-patient. We tested the system in nonpulsatile and pulsatile flow modes at two flow rates using a 40/60 glycerin/water blood analog, for a total of 48 trials, with n = 6 for each set-up. The pressure drops over the Medtronic ECLS were significantly higher than those over the MEDOS system regardless of the flow rate or perfusion mode (144.8 +/- 0.2 mm Hg vs. 35.7 +/- 0.2 mm Hg, respectively, at 500 mL/min in nonpulsatile mode, P < 0.001). The preoxygenator mean arterial pressures were significantly increased and the precannula hemodynamic energy values were decreased with the Medtronic ECLS circuit. These results suggest that the MEDOS ECLS circuit better transmits hemodynamic energy to the patient, keeps mean circuit pressures lower, and has lower pressure drops than the Medtronic Circuit.

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“…During pediatric cardiopulmonary bypass (CPB), a procedure intended to help patients overcome congenital heart defects, major factors such as deep hypothermic cardiac arrest, ischemia reperfusion, hypoperfusion, nonpulsatile perfusion, and the systemic inflammatory response often cause vital organ damage and patient injury at a critical period during the patient's development (1). The importance of adequate perfusion and reduced blood trauma cannot be underestimated as they directly translate into patient outcomes, especially in high‐risk patients.…”

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Comparison of Pumps and Oxygenators With Pulsatile and Nonpulsatile Modes in an Infant Cardiopulmonary Bypass Model

et al. 2009

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As the evidence mounts in favor of pulsatile perfusion during CPB, it is necessary to investigate the effect of circuit components on the quality of pulsatility delivered throughout the circuit. We compared two bloodpumps, the Jostra HL-20 heart-lung machine and the MEDOS DELTASTREAM DP1 Bloodpump, and two oxygenators, the Capiox Baby RX05 and the MEDOS HILITE 800LT, in terms of mean arterial pressure, energy equivalent pressure, surplus hemodynamic energy, total hemodynamic energy, and pressure drop over the oxygenators using a blood analog. The pumps and oxygenators were combined in unique circuits and tested in nonpulsatile and pulsatile modes, at two flow rates (500 and 800 mL/min), and three rotational speed differentials when using the MEDOS DELTASTREAM DP1 Bloodpump for 144 trials in total. The Jostra Roller pump produced some pulsatility in nonpulsatile mode and better pulsatility in pulsatile mode than the MEDOS DP1 Bloodpump at a rotational speed differential of 2500 rpm, but not at 3500 or 4500 rpm. The MEDOS DP1 Bloodpump produced almost no pulsatility in nonpulsatile mode. Pressure drops over the Capiox Baby RX05 were markedly higher, at 92.5 +/- 0.4 mm Hg with the MEDOS DP1 Bloodpump at 800 mL/min and 4500 rpm in pulsatile mode, than those of the MEDOS HILITE 800LT oxygenator, which was 67.0 +/- 0.1 mm Hg at the same settings. These results suggest that careful selection of each circuit component, based on the individual clinical case and component specifics, are necessary to achieve the best quality of pulsatility.

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Benefits of Pulsatile Perfusion on Vital Organ Recovery During and After Pediatric Open Heart Surgery

Cited by 63 publications

References 9 publications

Evaluation of Neonatal Membrane Oxygenators With Respect to Gaseous Microemboli Capture and Transmembrane Pressure Gradients

Evaluation of Neonatal Membrane Oxygenators With Respect to Gaseous Microemboli Capture and Transmembrane Pressure Gradients

Comparison of Two Types of Neonatal Extracorporeal Life Support Systems With Pulsatile and Nonpulsatile Flow

Comparison of Pumps and Oxygenators With Pulsatile and Nonpulsatile Modes in an Infant Cardiopulmonary Bypass Model

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