Measurement of gaseous microemboli in the prime before the initiation of cardiopulmonary bypass

Husebråten, Inger M; Fiane, Arnt E.; Ringdal, Mari-Anne I L; Thiara, Amrit P S

doi:10.1177/0267659117723454

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…135,136 In order to obtain the CO 2 content at 97e98% in the oxygenator, a single-centre study suggested that~5 min of flushing is necessary, whereas a more extended duration did not increase the value significantly. 135 Another important finding was that a CO 2 flush reduced GME in the prime and not in the arterial filtration. 136 One metaanalysis has been performed regarding the impact of CO 2 flooding on the neuropsychological outcome.…”

Section: Description Of the Evidencementioning

confidence: 99%

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Kunst

Milojevic

Boer

et al. 2019

British Journal of Anaesthesia

134

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Special Article responsible in the event of any contradiction, discrepancy and/or ambiguity between the EACTS, EACTA and EBCP Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS, EACTA and EBCP Guidelines fully into account when exercising their clinical judgement as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS, EACTA and EBCP Guidelines do not, in any way whatsoever, override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the EACTS, EACTA and EBCP Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. The article has been co-published with permission in the British Journal of Anaesthesia, the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery.

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Section: Description Of the Evidencementioning

confidence: 99%

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Kunst

Milojevic

Boer

et al. 2019

British Journal of Anaesthesia

134

View full text Add to dashboard Cite

show abstract

“…These properties contribute to a low priming volume, an efficient blood-air interface, and a biocompatible coating system, thus attenuating hemodilution. This system reduces priming volume by approximately 30-50% and the infusion rate of different blood products by approximately 3-15%, as observed in a variety of randomized control trials [11,12], meta-analyses [1,13], and observational studies [14]. The blood conservation efficacy of MiECC was also supported by class IIa B evidence in the 2019 EACTS/EACTA/EBCP guidelines on CPB in adult cardiac surgery [10], indicating a promising platform for improving the safety of cardiac surgery.…”

Section: Introductionmentioning

confidence: 82%

“…Compared with previous work, the fabricated CPB system in this study included several improvements, but inevitably had limitations. Previous studies have found that adding the CO 2 flush procedure contribute to a reduction of gaseous microemboli in CPB devices and corresponding improved neuropsychological outcomes [14,25,26]. Thus, we implemented the CO 2 flush procedure before surgery in our modified CPB system.…”

Section: Discussionmentioning

confidence: 99%

Modified cardiopulmonary bypass with low priming volume for blood conservation in cardiac valve replacement surgery

Yang

Huang

Dai

et al. 2023

J Cardiothorac Surg

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Background The adverse effects of cardiopulmonary bypass during open cardiac surgery, including hemodilution, seem to be inevitable, especially for patients who generally have a relatively lower BMI with relatively small blood volumes. This study reports the modification and use of a cardiopulmonary bypass (CPB) system to reduce priming volume and hemodilution. Methods This is a retrospective study of 462 adult patients who underwent cardiac valve replacement surgery from January 2019 to September 2021 at the General Hospital of Western Theater Command. The modified group consisted of 212 patients undergoing modified CPB. The control group included 250 patients receiving conventional CPB. Evaluated indices included fluid intake and output volumes during CPB, intraoperative indices related to CPB operation, usage of blood products during the peri-CPB period, and postoperative outcomes. Results The modified group displayed a significant reduction in the crystalloid (200 mL vs. 600 mL, P < 0.05) and colloid priming volumes (450 mL vs. 1100 mL, P < 0.05), and ultrafiltration solution volume (750 mL vs. 1200 mL, P < 0.05). Furthermore, the modified group had a significantly lower rate of defibrillation (30.2% vs. 41.2%, P < 0.05). The intraoperative urine volume (650 mL vs. 500 mL, P < 0.05) and intraoperative hematocrit (Hct) (26% vs. 24%, P < 0.05) of the modified CPB group were also higher than in the control group. The modified group required a lower infusion volume of packed red blood cells (250 mL vs. 400 mL, P < 0.05) and lower infusion rates of packed red blood cells (17.9% vs. 25.2%, P < 0.05) and fresh frozen plasma (1.41% vs. 5.2%, P < 0.05). In addition, the modified group showed significantly improved indices related to postoperative recovery. Conclusions The modified CPB system effectively conserves blood and shows noteworthy potential for application in cardiac valve replacement surgery.

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“…With regard to GME count, the removal efficiency of the NX19 is similar to the 89.6% decrease in GME count of the Capiox FX25 found by Johagen et al 11 Although the NX19's efficiency to handle GME is lower than the 99.1% removal found in the FX25 by Johagen et al, it is similar to the 95.03% removal by the Capiox FX25 measured by Stehouwer et al 12 There were differences in microemboli count and volume between the three participating centers, and in contrast to known literature, the center not using CO 2 flush had the lowest pre-oxygenator microemboli count. 13,14 This result, and other differences in microemboli count and volume between centers, can be attributed to the use of different custom packs, different priming fluids, as well as differences in priming technique. As the microembolic count and volume were small and no particularities occurred during any of the 150 priming rounds, the NX19 oxygenator showed to be effective in removing GME, despite the technical differences between centers.…”

Section: Discussionmentioning

confidence: 98%

Clinical evaluation of the novel Capiox NX19 adult oxygenator–a multicenter study

et al. 2022

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Introduction The novel Capiox NX19 adult oxygenator is, compared to its predecessors, improved with enhanced air removal technology, a polymer heat exchanger and smaller, innovative hollow fibers resulting in a surface area reduction and a lower priming volume. The aim of this study was to evaluate the NX19 oxygenator performance in a clinical setting. Methods A prospective multicenter study was performed involving three large European university hospitals. The Capiox NX19 ( n = 150) performance was assessed during adult cardiopulmonary bypass and involved gaseous microemboli handling and gas transfer efficiency. The heat exchanger performance was evaluated separately in vitro. Results The heat exchanger performance factors were 0.80 ± 0.03 and 0.58 ± 0.04 at pump flow rates of 3 L/min and 6 L/min, respectively. After priming, residual post-oxygenator gaseous microemboli count and volume were decreased by 91% and 93.7%, respectively. The gas compartment pressure was 6.0 ± 2.5 mmHg, while the O2 transfer was 69 ± 30 mL/min/m2 and the CO2 transfer 73 ± 34 mL/min/m2. The O2 gradient was 44 ± 19 mmHg/LPM and the O2 diffusing capacity 0.38 ± 0.14 mL/min/mmHg. The shunt fraction was 0.19 ± 0.13, whereas oxygenator resistance and shear stress were 10.5 ± 3.7 mmHg/LPM and 5.1 ± 3.1 dyn/cm2, respectively. Conclusion This multicenter study displayed good clinical safety and performance of the NX19 oxygenator.

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Measurement of gaseous microemboli in the prime before the initiation of cardiopulmonary bypass

Abstract: Flushing the bypass circuits with carbon dioxide before priming significantly decreased the number of gaseous microemboli in the priming solution.

Cited by 13 publications

References 21 publications

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Modified cardiopulmonary bypass with low priming volume for blood conservation in cardiac valve replacement surgery

Clinical evaluation of the novel Capiox NX19 adult oxygenator–a multicenter study

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