Dynamic bubble trap can replace an arterial filter during cardiopulmonary bypass surgery

Göritz, Stefan; Schelkle, Helmut; Rein, J; Urbanek, Simon

doi:10.1177/0267659106070564

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…We hypothesize that turbulence inside the DBT leads to a partial fragmentation of MB. At first look, these results are contradictory to previous publications . However, it needs to be highlighted that only MB with a diameter of up to 120 µm were measured in the published studies.…”

Section: Discussioncontrasting

confidence: 79%

“…Usually, DBT are used in heart-lung machines during cardiac surgery on cardiopulmonary bypass. 15,16 Usage of a DBT successfully reduced the total amount of MB as well as the total gas volume drastically, even in a setting of high MB activity. The best capacity was observed for large and very large MB: 96.22 ± 3.68% reduction of MB >150 µm and 100% reduction of MB >300 µm.…”

Section: Discussionmentioning

confidence: 99%

“…As another completely new option for MB reduction in ECLS therapy, we investigated the removal capacity of a DBT. Usually, DBT are used in heart‐lung machines during cardiac surgery on cardiopulmonary bypass . Usage of a DBT successfully reduced the total amount of MB as well as the total gas volume drastically, even in a setting of high MB activity.…”

Section: Discussionmentioning

confidence: 99%

“…At first look, these results are contradictory to previous publications. 15,18 However, it needs to be highlighted that only MB with a diameter of up to 120 µm were measured in the published studies. When just focusing on MB <120 µm we also observed an overall reduction of the MB.…”

Section: Discussionmentioning

confidence: 99%

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Generation of microbubbles in extracorporeal life support and assessment of new elimination strategies

et al. 2019

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Occurrence of microbubbles (MB) is a major problem during venoarterial extracorporeal life support (ECLS) with partially severe clinical complications. The aim of this study was to establish an in vitro ECLS setup for the generation and detection of MB. Furthermore, we assessed different MB elimination strategies. Patient and ECLS circuit were simulated using reservoirs, a centrifugal pump, a membrane oxygenator, and an occluder (modified roller pump). The system was primed with a glycerin solution of 44%. Three different revolution speeds (2500, 3000, and 3400 rpm) were applied. For MB generation, the inflow line of the pump was either statically or dynamically (15 rpm) occluded. A bubble counter was used for MB detection. The effectiveness of the oxygenator and dynamic bubble traps (DBTs) was evaluated in regard to MB elimination capacities. MB generation was highly dependent on negative pressure at the inflow line. Increasing revolution speeds and restriction of the inflow led to increased MB activity. The significant difference between inflow and outflow MB volume identified the centrifugal pump as a main source. We could show that the oxygenator’s ability to withhold larger MB is limited. The application of one or multiple DBTs leads to a significant reduction in MB count and overall gas volume. The application of DBT can significantly reduce the overall gas volume, especially at high flow rates. Moreover, large MB can effectively be broken down for faster absorption. In general, the incidence of MBs is significantly dependent on pump speed and restriction of the inflow. The centrifugal pump was identified as a major source of MB generation.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Generation of microbubbles in extracorporeal life support and assessment of new elimination strategies

et al. 2019

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“…As a safeguard for gross air and to reduce the number of GME in the arterial line arterial filters are incorporated in conventional pediatric and adult bypass circuits (5, 7, 8). A 40 μm arterial filter reduces the number of GME by 50% to 73% during adult CPB, thus providing a neuroprotective effect (9, 10).…”

Section: Introductionmentioning

confidence: 99%

In vitro Air Removal Characteristics of Two Neonatal Cardiopulmonary Bypass Systems: Filtration May Lead to Fractionation of Bubbles

Stehouwer

Kelder

Oeveren³

et al. 2014

Int J Artif Organs

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Introduction of gaseous microemboli (GME) into the arterial line of a pediatric cardiopulmonary bypass (CPB) circuit may lead to cognitive decline and adverse outcomes of the pediatric patient.Arterial filters are incorporated into CPB circuits as a safeguard for gross air and to reduce GME. Recently, arterial filters were integrated in two neonatal oxygenators to reduce volume and foreign surface area. In this study a clinical CPB scenario was simulated. The oxygenators, the corresponding venous reservoirs and the complete CPB circuits were compared regarding air removal and bubble size distribution after the introduction of an air bolus or GME. During a GME challenge, the Capiox FX05 oxygenator removed a significantly higher volume of GME than the QUADROX-i Neonatal oxygenator (97% vs. 86%). Detailed air removal characteristics showed that more GME in the range of 20-50 µm were leaving the devices than were entering. This phenomenon seems to be more present in the Capiox FX05. The circuits were also challenged with an air bolus. Each individual component tested removed 99.9%, which resulted in an air volume reduction of 99.99% by either complete CBP circuit. Overall, we conclude that both CPB systems were very adequate in removing GME and gross air. The air removal properties of both systems are considered safe and reliable. Detailed GME distribution data show that the Capiox FX05 showed more small GME (<50 µm) due to fractionation of larger GME when compared to the QUADROX-i Neonatal. We may conclude that filtration may lead to fractionation.

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What the cardiac surgeon always wanted to know about heart-lung machines

Benk

Klemm

Schaller

et al. 2008

Z Herz- Thorax- Gefäßchir

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Dynamic bubble trap can replace an arterial filter during cardiopulmonary bypass surgery

Abstract: The use of the DBT instead of the AF yields higher air microbubble removal efficacy, allowing replacement of the AF, assuming the AF is used for air removal purpose only.

Cited by 12 publications

References 29 publications

Generation of microbubbles in extracorporeal life support and assessment of new elimination strategies

Generation of microbubbles in extracorporeal life support and assessment of new elimination strategies

In vitro Air Removal Characteristics of Two Neonatal Cardiopulmonary Bypass Systems: Filtration May Lead to Fractionation of Bubbles

What the cardiac surgeon always wanted to know about heart-lung machines

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