Oxygenator thrombosis: an international phenomenon

Schaadt, Jennifer

doi:10.1177/026765919901400605

Cited by 39 publications

(37 citation statements)

References 22 publications

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“…Thus, any further reduction in these channels' dimensions, caused by depositions, would cause a marked increase in resistance to blood flow and an increase in transmembrane pressure. 6 It has also been noted that these pressure gradients are not limited to low-prime oxygenators, but that this phenomenon is more pronounced and occurs sooner in these than in higher-prime oxygenators. 5,6 Others have suggested that these increases in transmembrane pressures are caused by the activation of platelets and their subsequent deposition with fibrinogen on the membrane surface.…”

Section: Discussionmentioning

confidence: 97%

“…6 It has also been noted that these pressure gradients are not limited to low-prime oxygenators, but that this phenomenon is more pronounced and occurs sooner in these than in higher-prime oxygenators. 5,6 Others have suggested that these increases in transmembrane pressures are caused by the activation of platelets and their subsequent deposition with fibrinogen on the membrane surface. Aniuk et al have noted that many of these occurrences have been associated with the use of hydroxyethyl starches in the CPB priming solution.…”

Section: Discussionmentioning

confidence: 97%

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Parallel replacement of the oxygenator that is not transferring oxygen: the PRONTO procedure

et al. 2002

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We present here a technique to replace a failed oxygenator by inserting a second oxygenator in parallel (PRONTO) within the cardiopulmonary bypass (CPB) circuit. Oxygenator failure is a potential hazard that may result in patient injury or death. Although failures are rare, safety surveys conducted over the last 25 years suggest that the incidence of oxygenator failures is on the rise. This emergency procedure may be easily applied to any standard CPB circuit with a few minor alterations. The technique is simple; it can be carried out rapidly. An important advantage of this technique is that it may be executed without interrupting blood flow to the patient, which may reduce the incidence of patient injury or death.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Parallel replacement of the oxygenator that is not transferring oxygen: the PRONTO procedure

et al. 2002

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“…Over the past few years, the phenomenon of HPE has been well documented 14,19,20 in the absence of albumin. It has been shown to occur in all oxygenators, with all primes and probably in all centers 15,20 when albumin is eliminated from the prime.…”

Section: Partmentioning

confidence: 99%

Use of autologous blood as part of the perfusate for cardiopulmonary bypass: a priming technique

Myers¹,

Légaré²,

Sullivan³

et al. 2002

Perfusion

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In an attempt to replace the oncotic and protein coating capabilities of serum albumin in the perfusate, we established a priming protocol that used autologous blood as part of the perfusate solution. Prior to March 1, 1999, our standard priming protocol was 1650 ml of crystalloid with 250 ml of 5% serum albumin and 5,000 units of heparin. After removing albumin from our prime, our standard protocol was altered to include 40 ml of the patient's autologous blood in 1,800 ml of crystalloid and 10,000 units of heparin. To determine the intraoperative effects of using albumin/crystalloid primes (Group A), autologous blood/crystalloid primes (Group B) and crystalloid primes (Group C), a total of 178 patients were sequentially evaluated. Intraoperative parameters evaluated were total protein (TP), colloid osmotic pressure (COP), platelets (Plts) and fluid requirements during cardiopulmonary bypass (CPB). During an overlapping 12-month period of time, 1,092 consecutive cardiac surgical cases using CPB (584 albumin prime; 508 autologous blood prime) were evaluated for clinical outcomes in terms of mortality and length of hospitalization. In addition, over a period of 15 months, 1,458 patients in both the autologous blood/crystalloid group and the crystalloid only group were evaluated for the incidence of high-pressure excursions (HPE) after going on bypass. Comparative reviews of TP, COP and Plts demonstrated no significant difference 10 min after the start of bypass between Groups A and B. However, in Group C, there was a statistically significant increase in the intraoperative fluid requirements during CPB, compared to both of the other groups. There was no significant difference in the incidence of HPE, with an occurrence of 1.04% in the crystalloid only group and 1.11% in the autologous blood/crystalloid group. Autologous blood perfusates were identical to albumin perfusates in their platelet protection and reduction of fluid shifts during the intraoperative period.

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“…Currently, one of the major challenges in ECC device design is the minimization of flow-induced platelet activation, which is a major precursor of thromboembolic complications (Schaadt 1999). In comparison with hemolysis, platelet activation is responsible for the onset of thrombogenic phenomena that occur at shear stresses ten-fold lower than those responsible for red blood cell damage (Ramstack et al 1979).…”

Section: Introductionmentioning

confidence: 99%

Computational evaluation of the thrombogenic potential of a hollow-fiber oxygenator with integrated heat exchanger during extracorporeal circulation

Pelosi

Sheriff

Stevanella

et al. 2012

Biomech Model Mechanobiol

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The onset of thromboembolic phenomena in blood oxygenators, even in the presence of adequate anticoagulant strategies, is a relevant concern during extracorporeal circulation (ECC). For this reason, the evaluation of the thrombogenic potential associated with extracorporeal membrane oxygenators should play a critical role into the preclinical design process of these devices. This study extends the use of computational fluid dynamics simulations to guide the hemodynamic design optimization of oxygenators and evaluate their thrombogenic potential during ECC. The computational analysis accounted for both macro- (i.e., vortex formation) and micro-scale (i.e., flow-induced platelet activation) phenomena affecting the performances of a hollow-fiber membrane oxygenator with integrated heat exchanger. A multiscale Lagrangian approach was adopted to infer the trajectory and loading history experienced by platelet-like particles in the entire device and in a repetitive subunit of the fiber bundles. The loading history was incorporated into a damage accumulation model in order to estimate the platelet activation state (PAS) associated with repeated passes of the blood within the device. Our results highlighted the presence of blood stagnation areas in the inlet section that significantly increased the platelet activation levels in particles remaining trapped in this region. The order of magnitude of PAS in the device was the same as the one calculated for the components of the ECC tubing system, chosen as a term of comparison for their extensive diffusion. Interpolating the mean PAS values with respect to the number of passes, we obtained a straightforward prediction of the thrombogenic potential as a function of the duration of ECC.

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Oxygenator thrombosis: an international phenomenon

Cited by 39 publications

References 22 publications

Parallel replacement of the oxygenator that is not transferring oxygen: the PRONTO procedure

Parallel replacement of the oxygenator that is not transferring oxygen: the PRONTO procedure

Use of autologous blood as part of the perfusate for cardiopulmonary bypass: a priming technique

Computational evaluation of the thrombogenic potential of a hollow-fiber oxygenator with integrated heat exchanger during extracorporeal circulation

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