Pathologic fibrin formation and cold-induced clotting of membrane oxygenators during cardiopulmonary bypass

Blombäck, Margareta; Kronlund, Peter; Aberg, B; Fatah, K.; Hansson, Lars‐Olof; Egberg, Nils; Moor, Elizabeth; Carlsson, Kjell

doi:10.1016/s1053-0770(05)80053-9

Cited by 46 publications

(48 citation statements)

References 34 publications

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“…Similar experiences are reported by Blombäck et al 8 Over a two-year period, 11 cases of HPD were identified in 1800 cases (SI Ϸ 0.6). In three of these cases, the oxygenator had to be changed (SI Ϸ 0.2).…”

Section: Discussionsupporting

confidence: 86%

“…The specific SI of HPD ranged from 0 to 1.62, with the highest SI value in the Sarns SMO Turbo series. A variability between types of oxygenator was also evident in the report by Blombäck et al 8 The oxygenator represents a large foreign surface activating a sequence of humoral cascade systems on blood contact. 13 Activation of the intrinsic coagulation is presumably the prime cause of HPD.…”

Section: Discussionmentioning

confidence: 90%

“…12 Patients with elevated levels of fibrinogen and platelets may, therefore, be at a higher risk. 8 Our experience of HPD has not been able to pinpoint any common patient-related factor. Neither the use of aprotinin, high haematocrit, fibrinogen or platelet levels, cold agglutinins, or management of hypothermia have been conclusive.…”

Section: Discussionmentioning

confidence: 94%

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The relative safety of an oxygenator

et al. 1997

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Analysis of prospectively registered incidents related to cardiopulmonary bypass (CPB) was initiated to establish the incident rate for 10 different oxygenator brands employed over a seven-year period in 5000 clinical perfusions. A general safety index (SI) was defined as the number of recorded incidents in a given series of oxygenators divided by its total number and multiplied by 100. Specific SI was calculated for each of the following categories: high-pressure drop, debris, gas exchange, leakage, material failure and oxygenator change-out. An SI of 0.2 was arbitrarily set as a reference and an acceptable safety level. An estimate of the relative risk for a particular oxygenator brand was compared with the reference by calculating the odd's ratio with a 95% confidence interval. The mean SI was determined to be 1.6, ranging from 0 for the Maxima CBAS and the Cobe CML to 2.92 for the Safe oxygenator. The dominating specific type of incident was HPD with an SI of 0.81 followed by debris, SI = 0.71. A systematic analysis of adverse events in CPB may be used to evaluate and to set standards, a method already employed in the pharmaceutical industry. Our results indicate that oxygenator safety margins may vary between different brands.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 90%

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The relative safety of an oxygenator

et al. 1997

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“…In 1995, a Swedish study by Blömback et al 3 compared a variety of hematological indices in ten patients with normal oxygenator inlet pressures (control group) vs 11 patients exhibiting high oxygenator inlet pressures. Four brands of oxygenators were used, with all brands equally represented in both the control and the high inlet pressure groups.…”

Section: Literature Reviewmentioning

confidence: 99%

“…These investigations suggest that sudden withdrawal of aspirin may be disadvantageous in patients with cardiovascular disease, especially before CPB surgery, substantially increasing the risk of plasma clot formation with tight and rigid fibrin structures. 4 Blömback et al 3 concluded that cooling alone could not explain these clotting incidents. However, cooling in combination with abnormalities in cryoprecipitability may be the reason for clotting in the heat exchangers.…”

Section: Literature Reviewmentioning

confidence: 99%

Oxygenator thrombosis: an international phenomenon

Schaadt¹

1999

Perfusion

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Oxygenator thrombosis, despite adequate anticoagulation, has become a recent concern amongst perfusionists worldwide. The phenomenon is characterized by a transient increase in oxygenator inlet pressure of up to 900 mmHg about 10-15 min after the institution of cardiopulmonary bypass (CPB). Depending on the size and location of the thrombus, shunting may occur that compromises gas transfer to the extent where oxygenator change-out is necessary. This article presents various case reports and publications, both domestic and international, detailing this phenomenon. Research hypothesizes that it is the activation of platelets that subsequently may cause the deposition of fibrin, yielding thrombus formation; however, the primary etiology of this phenomenon remains unknown. Possible catalysts include bypass techniques, equipment selection, pharmacological agents, prime and the patient. This paper will review all of the above with an emphasis on the often overlooked factor--the patient, as there are certain variables in patient hematology that provoke a hypercoagulable state leading to thrombosis, including blood type, genetics, age, disease state, gender and heparin.

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