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

Abstract

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.

Effect of cannulation site on emboli travel during cardiac surgery

“…We suspect that, due to improving filter capacity of CPB components or to breaking down of large bubbles [ 23 ], ECC Bubbles (even though they are clearly present) are generally less dangerous than Heart Bubbles because of their presumed smaller size. Nevertheless, the possibility that dangerous air bubbles are generated during cardiac surgery cannot be excluded a priori and necessary precautions should be taken.…”

Assessment of three methods for removing massive air in a cardiopulmonary bypass circuit: simulation-based multi-discipline training in West China Hospital

“…16,17 As the technologies of CPB materials advance, new generations of oxygenators, like the CAPIOX FX05 and the Affinity Fusion, come with builtin ALF that is equivalent to the 25 µm ALF. [18][19][20] Oxygenators like the Medtronic Pixie and NT have much tighter hollow-fiber structures which can serve as air exchangers as well as arterial filters. 18,21,22 Although this progressive fiber-bundle filtration is not as efficient as that of the CAPIOX FX05 and Affinity Fusion, it is able to deliver part of the arterial filter functionality.…”

“…[18][19][20] Oxygenators like the Medtronic Pixie and NT have much tighter hollow-fiber structures which can serve as air exchangers as well as arterial filters. 18,21,22 Although this progressive fiber-bundle filtration is not as efficient as that of the CAPIOX FX05 and Affinity Fusion, it is able to deliver part of the arterial filter functionality. 18,21,22 In Western countries, simulation-based training is one of the admission courses for cardiac residents, as well as perfusionist training and practice.…”

“…18,21,22 Although this progressive fiber-bundle filtration is not as efficient as that of the CAPIOX FX05 and Affinity Fusion, it is able to deliver part of the arterial filter functionality. 18,21,22 In Western countries, simulation-based training is one of the admission courses for cardiac residents, as well as perfusionist training and practice. [23][24][25][26][27][28] Training performances are evaluated skill wise and non-skill wise.…”

“…18,21,22 Although this progressive fiber-bundle filtration is not as efficient as that of the CAPIOX FX05 and Affinity Fusion, it is able to deliver part of the arterial filter functionality. 18,21,22…”