Erythrocyte Crenation Induced by Free Fatty Acids in Patients Undergoing Extracorporeal Circulation

Kamada, Takenobu; Sternlieb, JackJ.; McMillan, D.T.; Björk, V. O.; Otsuji, S

doi:10.1016/s0140-6736(87)91013-0

Cited by 25 publications

(7 citation statements)

References 11 publications

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“…Cardiopulmonary bypass is associated with an increase in hydrogen peroxide in blood [39], vitamin E depletion [40], and increase in plasma 2-thiobarbituric acid reactive substance levels in most but not all studies [41,42]. In the study by Kamada et al, where the plasma lipoperoxide levels were not increased, the priming solution contained 500 ml of 20% mannitol, a known scavenger of the hydroxyl radical [43]. Limb ischemic preconditioning may limit lipid peroxide production in children undergoing open heart surgery [44].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Induced Cardiac Dysfunction in Newborn Lambs

Pyles

Gustafson

Fortney

et al. 2010

J. of Cardiovasc. Trans. Res.

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Extracorporeal membrane oxygenation (ECMO) is routinely used to support cardiopulmonary failure in infants and children. Suboptimal outcomes for primary cardiac support suggest a need for investigation of the impact of ECMO on the heart. Twenty-four newborn lambs received a brief period of ECMO support to investigate the hypothesis that ECMO produces cardiac dysfunction in newborn lamb. Dorset newborn lambs, 4-7 days of age, were exposed to ECMO for 5 min at a 100 ml/kg flow rate and quickly weaned off. Measurements included echocardiographic mean left ventricular (LV) velocity of circumferential fiber shortening corrected for heart rate (mVCFc), LV shortening fraction, and peak systolic wall stress plus hemodynamic measurement of LV maximum rate of pressure change with time (LV dp/dt max), maximum rate of pressure change divided by developed pressure (LV dp/dtP), right atrial pressure, pulmonary capillary wedge pressure, mean pulmonary artery pressure, LV peak and end-diastolic pressure, and aortic pressure. These measures were also obtained after an exposure to 5 min of ECMO and immediate disconnect for 5 min, followed by ECMO administration for 1 h again, followed by discontinuation of ECMO. LV mVCFc is decreased after exposure to 5 min of ECMO support despite a decrease in LV peak systolic wall stress that provides afterload reduction. LV mVCFc is inversely related to peak systolic wall stress at a significance level of p < 0.0001. The time period after initiation of ECMO is a significant factor in the model (p = 0.0097). Time [baseline] was different from the other time points with p = 0.0010. Average mVCFc at baseline is 1.27 ± 0.35 and decreases to 1.01 ± 0.42 after 5 min of ECMO that is then withdrawn. Peak systolic wall stress decreases from 36.0 ± 13.1 at baseline to 29.8 ± 12.1 after 5 min of ECMO. LV dp/dt max decreases from 1,769 ± 453 mmHg/s at baseline to 1,311 ± 513 mmHg/s after exposure to 5 min of ECMO (p = 0.0005). Baseline LV dp/dt max is different from each point after start of ECMO. Diastolic LVdp/dt min increased from -1,340 ± 477 mmHg/s to -908 ± 393 mmHg/s at 5 min. Echocardiographic mVCFc, when considered in isolation or as a function of LV peak systolic wall stress, shows diminished LV function after ECMO. Hemodynamic measurement of LV dp/dt max and LV dp/dt min confirms the observation. Separation of the humoral from mechanical effect of ECMO with the short exposure to the extracorporeal circuit shows that an immediate decrement of LV function occurs at initiation of ECMO, a finding that has not been stressed with previous studies of extracorporeal support. This implies a potentially outcome-limiting deleterious effect for the patient who requires ECMO support for the heart rather than the lungs. We should continue to strive to understand and ameliorate this deleterious effect of the extracorporeal circulation circuit.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Induced Cardiac Dysfunction in Newborn Lambs

Pyles

Gustafson

Fortney

et al. 2010

J. of Cardiovasc. Trans. Res.

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“…In clinical studies by Kamada et al . [11, 12], alterations in erythrocyte morphology were observed in patients undergoing extracorporeal circulation with crystalloid prime solution and the proportion of altered red blood cells was reduced by albumin administration.…”

Section: Discussionmentioning

confidence: 99%

Protective effects of plasma replacement fluids on erythrocytes exposed to mechanical stress

et al. 2000

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SummaryHaemoglobin release from 40 suspensions of packed red blood cells in modified fluid gelatin, 4% albumin solution, 6% hydroxyethyl starch and normal saline was investigated in vitro during circulation with a roller pump from a heart±lung machine for 120 min at a flow rate of 2.5 l.min 21 at room temperature. The lowest haemoglobin release was obtained with erythrocytes in modified fluid gelatin, whereas free haemoglobin concentrations became progressively higher with albumin, hydroxyethyl starch and normal saline [median free haemoglobin (interquartile range) after 120 min circulation: gelatin 493 (360±601) mg.l 21 , albumin 692 (590±1111) mg.l 21 , hydroxyethyl starch 1121 (692±1518) mg.l 21 , normal saline 1178 (881±1757) mg.l 21 , p , 0.001]. Modified fluid gelatin appears to have potent erythrocyte protective properties similar to those of albumin. This effect could decrease mechanical haemolysis during extracorporeal circulation or cell saver autotransfusion if modified fluid gelatin is used as part of a priming solution or as an additive in wash solutions.

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“…Dieses Phänomen wurde von Ponder ¹Disk-Sphereª Transformation und in der neueren Literatur reversible Diskozyten-Echinozyten-Transformation genannt [4 ± 6, 9, 25]. Das Auftreten von pathologischen Erythrozytenformen während extrakorporaler Zirkulation und eine Prävention dieser Veränderungen durch Albumin konnten auch in vivo beobachtet werden [21,22,31].…”

Section: Beeinflussung Der Erythrozytenmorphologieunclassified

Gelatine schützt Erythrozyten in vitro und in vivo vor mechanischer Belastung

Sümpelmann

Zander²

2001

Anasthesiol Intensivmed Notfallmed Schmerzthe

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Erythrocyte Crenation Induced by Free Fatty Acids in Patients Undergoing Extracorporeal Circulation

Cited by 25 publications

References 11 publications

Extracorporeal Membrane Oxygenation Induced Cardiac Dysfunction in Newborn Lambs

Extracorporeal Membrane Oxygenation Induced Cardiac Dysfunction in Newborn Lambs

Protective effects of plasma replacement fluids on erythrocytes exposed to mechanical stress

Gelatine schützt Erythrozyten in vitro und in vivo vor mechanischer Belastung

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