Cardiopulmonary bypass: Evidence or experience based?

Bartels, Claus; Gerdes, Anja; Babin‐Ebell, Jörg; Beyersdorf, Friedhelm; Boeken, Udo; Doenst, Torsten; Feindt, P.; Heiermann, Michael; Schlensak, Christian; Sievers, Hans‐Hinrich

doi:10.1067/mtc.2002.121506

Cited by 59 publications

(40 citation statements)

References 23 publications

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“…In addition, urine fl ow as an indicator of renal function during operation was positively correlated to mean arterial pressure on cardiopulmonary bypass, but there was no effect on postoperative renal function [22,23] . As recent studies have demonstrated that cardiopulmonary bypass management is not evidence based [24] , our current clinical pulsatile perfusion practice may favor renal dysfunction. Therefore, the purpose of our study was to investigate whether clinical routine pulsatile fl ow management infl uences postcardiac surgery renal function.…”

Section: Introductionmentioning

confidence: 99%

Pulsatile Flow Improves Renal Function in High-Risk Cardiac Operations

Kocakulak

Aşkın²,

Küçükaksu³

et al. 2005

Blood Purif

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The effects of pulsatile perfusion on microcirculation and renal function in high-risk patients were evaluated in this study. Pulsatile roller pumps with a pulsatile control module and membrane oxygenator were used in a clinical setting. 40 patients undergoing elective cardiac surgery with a high risk of either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be perfused using pulsatile or continuous flows. Blood samples were collected at induction of anesthesia, at the time of aortic clamping and declamping and 1 and 24 h following cessation of the bypass. Urea and creatinine concentrations in blood were measured and systemic vascular resistance was calculated. Urine output, crystalloid and colloid infusions were recorded. We observed that pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study improved microcirculation and renal function in high-risk patients undergoing cardiopulmonary bypass.

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Section: Introductionmentioning

confidence: 99%

Pulsatile Flow Improves Renal Function in High-Risk Cardiac Operations

Kocakulak

Aşkın²,

Küçükaksu³

et al. 2005

Blood Purif

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“…5 In this setting, the development of scoring systems, such as the QualyP Score, might represent an advantage and a first step towards the definition of goal-directed perfusion strategies and quality benchmarking.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, several surveys proved that the scientific data available at present are not yet sufficient to serve as evidence-based guidelines. 5,6 The present study aims to evaluate the quality of organ perfusion during CPB and to structure a scoring system to assess The aim of this study was to ascertain if a score, directly derived from CPB records, could correlate to major postoperative outcomes. Methods: An additive score (QualyPscore) was created from 10 parameters: peak lactate value during CPB, peak VCO 2 i, lowest DO 2 i/VCO 2 i, peak respiratory quotient, CPB time, cross-clamp time, lowest CPB temperature, circulatory arrest, ultrafiltration during CPB, number of packed red cells transfused intraoperatively.…”

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confidence: 99%

Designing a new scoring system (QualyP Score) correlating the management of cardiopulmonary bypass to postoperative outcomes

et al. 2014

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Since the first successful clinical applications of cardiopulmonary bypass (CPB) in the early 1950s, the role of extracorporeal circulation has shifted progressively from a mere substitution of the heart and lungs towards the more complex field of organ perfusion.Therefore, numerous investigations have been performed to individuate which parameters might better associate with an improved organ perfusion during CPB. [1][2][3][4] Consequently, the application of the physiological concepts of metabolic needs to the setting of CPB promoted the concept of the so-called "goal-directed" perfusion. 2 However, several surveys proved that the scientific data available at present are not yet sufficient to serve as evidence-based guidelines. 5,6 The present study aims to evaluate the quality of organ perfusion during CPB and to structure a scoring system to assess The aim of this study was to ascertain if a score, directly derived from CPB records, could correlate to major postoperative outcomes. Methods: An additive score (QualyPscore) was created from 10 parameters: peak lactate value during CPB, peak VCO 2 i, lowest DO 2 i/VCO 2 i, peak respiratory quotient, CPB time, cross-clamp time, lowest CPB temperature, circulatory arrest, ultrafiltration during CPB, number of packed red cells transfused intraoperatively. The PerfSCORE was calculated, as well. Multivariable logistic regression models were built to detect the independent predictors of: peak lactates >3 mmol/L during the first three postoperative days; the incidence of acute kidney injury network (AKIN) 1-2-3; respiratory insufficiency; mortality. Results: The mean score was 4.8±2.6 (0-10). A QualyPscore ≥1 was predictive of postoperative acidosis (OR=1.595). A score ≥2 was predictive of AKIN 2 (OR=1.268) and respiratory insufficiency (OR=1.526). A score ≥5 was predictive of AKIN 3 (OR=1.848) and mortality (OR=1.497). Conclusions: QualyPscore may help to provide a quality marker of perfusion, emphasizing the need for goal-directed perfusion strategies.

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“…The promotion of neutropenia by leukocyte depletion filter (LDF) [11] and radiation [39], the association between NO and hypothermia during CPB reducing the adherence of leukocytes to the endothelium [40], the modifications of the cardioplegic solution [41], heparinization of the surface of the CPB system, the addition of anti-inflammatory and chelating agents of OFR to the circuit [4.42 to 44], were not sufficient to reduce inflammatory markers in the postoperative period and to support the standardization of with any of these alternatives to the procedure of CPB [45].…”

Section: Attenuation Of the Inflammatory Response: Actions On Neutropmentioning

confidence: 99%

Os leucócitos e a resposta inflamatória na lesão de isquemia-reperfusão

Francischetti¹,

Moreno²,

Scholz³

et al. 2010

Rev Bras Cir Cardiovasc

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The events of ischemia-reperfusion injury trigger a systemic inflammatory response that can lead to cellular damage and even organ failure. Such effects are noted in the post-operative recovery, especially with the use of cardiopulmonary bypass. Nowadays, we know that leukocytes play an important role in this process. Therefore, this study addresses the role of leukocytes in the pathophysiology of ischemia-reperfusion injury and activation of inflammatory cascades through this process and seeks to help in understanding these mechanisms as well as bringing contributions on the therapeutic approaches that may mitigate them. This retrospective review was performed from scientific papers published over the past ten years, in Portuguese and English, indexed in international databases of Medline, SciELO and related classical texts. The descriptors investigated were: ischemiareperfusion, leukocytes, inflammatory response, cardiopulmonary bypass, adverse effects and apoptosis.Keywords: Cardiopulmonary bypass. Leukocytes. Ischemia. Reperfusion injury. ResumoOs eventos de isquemia-reperfusão desencadeiam uma resposta inflamatória sistêmica que pode levar a lesões celulares e até falência de órgãos. Tais repercussões são notadas no pós-operatório de cirurgias, em especial, com o uso de circulação extracorpórea. Sabe-se, atualmente, que os leucócitos exercem importante papel neste processo. Assim, este estudo aborda o papel dos leucócitos na fisiopatologia das lesões de isquemia-reperfusão e a ativação das cascatas inflamatórias por esse processo e procura auxiliar na compreensão destes mecanismos assim como trazer contribuições acerca das abordagens terapêuticas que possam atenuá-los. Esta revisão bibliográfica retrospectiva foi realizada a partir de documentos científicos publicados nos últimos dez anos, em português e inglês, indexados em bases de dados internacionais Medline e SciELO e de textos clássicos relacionados. Os descritores pesquisados foram: isquemia-reperfusão, leucócitos, resposta inflamatória, circulação extracorpórea, efeitos adversos e apoptose.Descritores: Circulação extracorpórea. Leucócitos. Isquemia. Traumatismo por reperfusão. FRANCISCHETTI, I ET AL -Leukocytes and the inflammatory response in ischemia-reperfusion injuryRev Bras Cir Cardiovasc 2010; 25(4): 575-584

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Cardiopulmonary bypass: Evidence or experience based?

Abstract: The scientific data concerning the effectiveness and safety of key principles of cardiopulmonary bypass are insufficient in both amount and quality of scientific evidence to serve as a basis for practical, evidence-based guidelines.

Cited by 59 publications

References 23 publications

Pulsatile Flow Improves Renal Function in High-Risk Cardiac Operations

Pulsatile Flow Improves Renal Function in High-Risk Cardiac Operations

Designing a new scoring system (QualyP Score) correlating the management of cardiopulmonary bypass to postoperative outcomes

Os leucócitos e a resposta inflamatória na lesão de isquemia-reperfusão

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