Insulin binding to the cardiopulmonary bypass biomaterials

Urban, Kristyn; Redford, Daniel T.; Larson, Douglas F.

doi:10.1177/0267659107081632

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…found a better PLT protection after phosphorylcholine‐coated versus uncoated oxygenators (16). X‐coating has proven: (i) to reduce the absorption of plasma proteins (17), (ii) to improve the entrapment of circulating WBCs with the potential benefit to attenuate SIRS (18), and (iii) to optimize the hemostasis and to reduce homologous blood transfusions (19) when compared to uncoated circuits. Accordingly, the recent 2011 update to the Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines incorporated these evidences and stated that “the use of biocompatible CPB circuits may be considered as part of a multimodality program for blood conservation,” having this statement a Level of Evidence A (20).…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of New Generation Oxygenators With Integrated Arterial Line Filters for Cardiopulmonary Bypass

Onorati¹,

Santini²,

Raffin³

et al. 2012

Artificial Organs

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New generation oxygenators with integrated arterial line filters have been marketed to improve the efficacy of cardiopulmonary bypass (CPB). Differences in designs, materials, coating surfaces, pore size of arterial filter, and static prime exist between the oxygenators. Despite abundant preclinical data, literature lacks clinical studies. From September 2010 to March 2011, 80 consecutive patients were randomized to CPB using Terumo Capiox FX25 (40 patients, Group-T) or Sorin Synthesis (40 patients, Group-S) oxygenators. Pressure drop and gas exchange efficacy were registered during CPB. High-sensitivity C-reactive protein (hs-CRP), white blood cells (WBCs), fluid balance, activated clotting time, international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, platelets (PLTs), serum albumin, and total proteins were measured perioperatively at different timepoints. Clinical outcome was recorded. Repeated measure analysis of variance and nonparametric statistics assessed between-groups and during time differences. The two groups showed similar baseline and intraoperative variables. No differences were recorded in pressure drop and gas exchange (group-P and group*time-P = N.S. for all) during CPB. Despite similar fluid balance (P = N.S. for static/dynamic priming and ΔVolume administered intraoperatively), Group-T showed higher hs-CRP (group-P = 0.034), aPTT (group-P = 0.0001), and INR (group-P= 0.05), with lower serum albumin (group-P = 0.014), total proteins (group-P = 0.0001), fibrinogen (group-P = 0.041), and PLTs (group-P = 0.021). Group-T also showed higher postoperative bleeding (group-P = 0.009) and need for transfusions (P = 0.008 for packed red cells and P = 0.0001 for fresh frozen plasma and total transfused volumes). However, clinical outcome was comparable (P = N.S. for all clinical endpoints). Both oxygenators proved effective and resulted in comparable clinical outcomes. However, Sorin Synthesis seems to reduce inflammation and better preserve the coagulative cascade and serum proteins, resulting in lower transfusions and post-CPB inflammatory response.

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Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of New Generation Oxygenators With Integrated Arterial Line Filters for Cardiopulmonary Bypass

Onorati¹,

Santini²,

Raffin³

et al. 2012

Artificial Organs

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“…Newer ECMO systems may demonstrate significant differences in drug disposition compared with older systems, which may influence how pharmacotherapy is delivered in clinical practice. [10][11][12][13][14][15] Despite an absence of evidence-based dosing guidelines, anti-infectives and anti-fungals are commonly used in the setting of ECMO and a resurgence of research in this area has begun as evidence-based dosing regimens with ECMO are virtually non-existent to inform the clinical management of patients with infections receiving ECMO. [10][11][12] In addition to patient related factors, traditionally, lipophilicity, protein binding, and molecule size have been implicated for the pharmacokinetic changes observed within ECMO.…”

Section: Oxygenator Impact On Voriconazole In Extracorporeal Membranementioning

confidence: 99%

Oxygenator impact on voriconazole in extracorporeal membrane oxygenation circuits

Cies

Moore²,

Giliam

et al. 2020

Perfusion

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Introduction: To determine the oxygenator impact on alterations of voriconazole in a contemporary neonatal/pediatric (1/4 inch) and adolescent/adult (3/8 inch) extracorporeal membrane oxygenation circuit including the Quadrox-i® oxygenator. Methods: Simulated closed-loop extracorporeal membrane oxygenation circuits (1/4 and 3/8 inch) were prepared with a Quadrox-i pediatric and Quadrox-i adult oxygenator and blood primed. In addition, 1/4- and 3/8-inch circuits were also prepared without an oxygenator in series. A one-time dose of voriconazole was administered into the circuits, and serial pre- and post-oxygenator concentrations were obtained at 5 minutes, 1, 2, 3, 4, 5, 6, and 24 hour time points. Voriconazole was also maintained in a glass vial and samples were taken from the vial at the same time periods for control purposes to assess for spontaneous drug degradation Results: For the 1/4-inch circuit, there was an approximate mean of 64-67% voriconazole loss with the oxygenator in series and mean of 15-20% voriconazole loss without an oxygenator in series at 24 hours. For the 3/8-inch circuit, there was an approximate mean of 44-51% voriconazole loss with the oxygenator in series and a mean of 8-12% voriconazole loss without an oxygenator in series at 24 hours. The reference voriconazole concentrations remained relatively constant during the entire study period demonstrating that the drug loss in each size of the extracorporeal membrane oxygenation circuit with or without an oxygenator was not a result of spontaneous drug degradation. Conclusion: This ex vivo investigation demonstrated substantial voriconazole loss within an extracorporeal membrane oxygenation circuit with an oxygenator in series with both sizes of the Quadrox-i oxygenator at 24 hours and no significant voriconazole loss in the absence of an oxygenator. Further evaluations with multiple dose in vitro and in vivo investigations are needed before specific voriconazole dosing recommendations can be made for clinical application with extracorporeal membrane oxygenation.

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“…In vitro assays available to answer questions of biomaterial and device interactions with blood include both static and circulating blood systems. Static assays include fluorescence-based fibrinogen adsorption or platelet adhesion 16,25 in 96-well microtiter plates while circulating blood assays would make use of the Chandler loop system which recirculates blood in a rotating closed loop. 97,99–102…”

Section: Introductionmentioning

confidence: 99%

Development and hemocompatibility testing of nitric oxide releasing polymers using a rabbit model of thrombogenicity

et al. 2014

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Hemocompatibility is the goal for any biomaterial contained in extracorporeal life supporting (ECLS) medical devices. The hallmarks for hemocompatibility include nonthrombogenicity, platelet preservation and maintained platelet function. Both in vitro and in vivo assays testing for compatibility of the blood/biomaterial interface have been used over the last several decades to ascertain if the biomaterial used in medical tubing and devices will require systemic anticoagulation for viability. Over the last 50 years systemic anticoagulation with heparin has been the gold standard in maintaining effective ECLS. However, the biomaterial that maintains effective ECLS without the use of any systemic anticoagulant has remained elusive. In this review, the in vivo 4-h rabbit thrombogenicity model genesis will be described with emphasis on biomaterials that may require no systemic anticoagulation for ECLS longevity. These novel biomaterials may improve extracorporeal circulation (ECC) hemocompatibility by preserving near resting physiology of the major blood components, the platelets and monocytes. The rabbit ECC model provides a complete assessment of biomaterial interactions with the intrinsic coagulation players, the circulating platelet and monocytes. This total picture of blood/biomaterial interaction suggests that this rabbit thrombogenicity model could provide a standardization for biomaterial hemocompatibility testing.

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Insulin binding to the cardiopulmonary bypass biomaterials

Cited by 12 publications

References 21 publications

Clinical Evaluation of New Generation Oxygenators With Integrated Arterial Line Filters for Cardiopulmonary Bypass

Clinical Evaluation of New Generation Oxygenators With Integrated Arterial Line Filters for Cardiopulmonary Bypass

Oxygenator impact on voriconazole in extracorporeal membrane oxygenation circuits

Development and hemocompatibility testing of nitric oxide releasing polymers using a rabbit model of thrombogenicity

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