In Situ Control of Cardiotomy Suction Reduces Blood Trauma

Tevaearai, Hendrik T.; Mueller, Xavier M.; Horisberger, Judith; Augstburger, Monique; Bock, H. E.; Knörr, A; Segesser, Ludwig K. von

doi:10.1097/00002480-199809000-00010

Cited by 19 publications

(16 citation statements)

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“…The damage caused by CS on other blood elements has been reported by Tevaearai et al in a bovine model with specific emphasis on normalized PFH and platelet values in which the SS was able to significantly attenuate the damage (13). In our study, we also showed better blood element conservation of normalized erythrocytes, Hct, and Hb with the use of the SS (Table 3).…”

Section: Hemolysis and Cardiotomy Suction 27supporting

confidence: 82%

“…However, this novel SS has already shown its superiority over traditional devices used for CS in experimental settings (13,14). The SS has also been used clinically with success together with beating heart CPB systems (22).…”

Section: Hemolysis and Cardiotomy Suction 27mentioning

confidence: 99%

“…A novel remote-controlled automatic suction system, Smartsuction (SS), has already been tested in an experimental setting and has been shown to be less hemolytic versus standard continuous aspiration and when compared with the cell saver (13,14). It consists of an optic sensor placed at its tip that aspirates only when the sensor detects blood, thus minimizing blood-air mixing.…”

mentioning

confidence: 99%

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A Novel Device for Reducing Hemolysis Provoked by Cardiotomy Suction During Open Heart Cardiopulmonary Bypass Surgery: A Randomized Prospective Study

et al. 2006

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Since the inception of cardiopulmonary bypass (CPB), little progress has been made concerning the design of cardiotomy suction (CS). Because this is a major source of hemolysis, we decided to test a novel device (Smartsuction [SS]) specifically aimed at minimizing hemolysis during CPB in a clinical setting. Block randomization was carried out on a treated group (SS, n=28) and a control group (CTRL, n=26). Biochemical parameters were taken pre-, peri-, and post CPB and were compared between the two groups using the Student's t-test with statistical significance when P<0.05. No significant differences in patient demographics were observed between the two groups. Lactate dehydrogenase (LDH) and plasma free hemoglobin (PFH) pre-CPB were comparable for the CTRL and SS groups, respectively. LDH peri-CPB was 275+/-100 U/L versus 207+/-83 U/L for the CTRL and SS groups, respectively (P<0.05). PFH was 486+/-204 mg/L versus 351+/-176 mg/L for the CTRL and SS groups, respectively (P<0.05). LDH post CPB was 354+/-116 U/L versus 275+/-89 U/L for the CTRL and SS groups, respectively (P<0.05). PFH was 549+/-271 mg/L versus 460+/-254 mg/L for the CTRL and SS groups, respectively (P<0.05). Preoperative hematocrit (Hct) of 43+/-5% (CTRL) versus 37+/-5% (SS), and hemoglobin (Hb) of 141+/-16 g/L (CTRL) versus 122+/-17 g/L (SS) were significantly lower in the SS group. However, when normalized (N), the SS was capable of conserving Hct, Hb, and erythrocyte count perioperatively. Erythrocytes (N) were 59+/-5% (CTRL) versus 67+/-9% (SS); Hct (N) was 59+/-6% (CTRL) versus 68+/-9% (SS), and Hb (N) was 61+/-6% (CTRL) versus 70+/-10% (SS) (all P<0.05). This novel SS device evokes significantly lowered blood PFH and LDH values peri- and post CPB compared with the CTRL blood using a CS system. The SS may be a valuable alternative compared to traditional CS techniques.

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Section: Hemolysis and Cardiotomy Suction 27supporting

confidence: 82%

Section: Hemolysis and Cardiotomy Suction 27mentioning

confidence: 99%

mentioning

confidence: 99%

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A Novel Device for Reducing Hemolysis Provoked by Cardiotomy Suction During Open Heart Cardiopulmonary Bypass Surgery: A Randomized Prospective Study

et al. 2006

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“…This was because the only logical approach to reducing/eliminating this source of shear stress is by reducing/removing the air interface. In 1998, Tevaearai et al 17 used a bovine model to compare automatic suction and continuous suction. The researchers reported that automatic suction system reduces the amount of air entrained with the blood.…”

Section: Experiments 2 Identification Of Damaging Forcesmentioning

confidence: 99%

Investigation and quantification of the blood trauma caused by the combined dynamic forces experienced during cardiopulmonary bypass

2000

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Blood is exposed to various dynamic forces during cardiopulmonary bypass (CPB). Understanding the damaging nature of these forces is paramount for research and development of the CPB circuit. The object of this study was to identify the most damaging dynamic non-physiological forces and then quantify this damage. A series of in vitro experiments simulated the different combinations of dynamic forces experienced during CPB while damage to the blood was closely monitored. A combination of air interface (a) and negative pressure (P) caused the greatest rate of change in plasma Hb (deltap Hb) (4.94 x 10(-3) mg/dl/s) followed by negative pressure and then an air interface. Shear stresses, positive pressures, wall impact forces and a blood-nonendothelial surface caused the least damage (0.26 x 10(-3) mg/dl/s). An air interface showed no threshold value for blood damage, with the relationship between the size of the interface and the blood damage modelled by a second-order polynomial. However, negative pressure did exhibit a threshold value at -120 mm Hg, beyond which point there was a linear relationship. Investigating the reasons for the increased blood trauma caused by the low-pressure suction (LPS) system makes it clear how research into minimizing or completely avoiding certain forces must be the next step to advancing extracorporeal technology.

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“…Cardiotomy suction is a signifi cant source of red cell hemolysis and a potential source of cytokine and leukocyte activation [189] secondary to air-blood intermixing. A new technology-Smart System-reduces air-blood intermixing by turning on only in the presence of blood [190]. Although Smart technology does reduce hemolysis, it may not contribute signifi cantly to reducing the infl ammatory response [191].…”

Section: The Inflammatory Response To Cardiopulmonary Bypassmentioning

confidence: 99%