Peripheral tissue oxygenation during standard CPB and miniaturized CPB (direct oxymetric tissue perfusion monitoring study)

Abstract

Aim. The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) with mini CPB on peripheral tissue perfusion. Methods. 24 patients with ischemic heart disease scheduled for CPB were randomised to two groups: Group A (12 patients, standard CPB) and Group B (12 patients, mini CPB). Oxygen tension was measured with an optical multiparametric sensor inserted into the patient's deltoid muscle. Results. Lower priming in Group B (870 ± 221 mL) vs. Group A (1502 ± 48 mL) and significantly reduced hemodilution during mini CPB (Group B 25.3 ± 1.1% vs. Group A 30.1 ± 2.3%) were recorded. Higher and continuous blood flow during perfusion was analysed in Group A (4.58 ± 0.34 L.min ). There was a direct correlation between mean arterial pressure (MAP) and ptO 2 in Group A during CPB and a direct correlation between pump blood flow and MAP during CPB in Group B. Higher levels of ptO 2 during CPB and surgery after CPB in comparison with initial levels were found in Group B. Decreased ptO 2 levels after surgery were found in both groups. Conclusion. Mini CPB enables perfusion with a relatively low flow. The results of this study suggest that a flow decrease in mini CPB is well tolerated by the organism.

Modular minimally invasive extracorporeal circulation ensures perfusion safety and technical feasibility in cardiac surgery; a systematic review of the literature

“…This has been extensively studied by Bennett et al and Mandak et al, who both confirmed that relatively low flow with MiECC is associated with preserved oxygen delivery and is well tolerated by the body, explained by markedly reduced hemodilution. 34,35 Moreover, it has been proved that MiECC optimizes microvascular perfusion by pre-serving and enhancing recovery of microcirculatory blood flow. 36,37 Loss of this balance due to conversion from a closed to an open circuit, as shown in our study, leads to hemodultion and increased lactate production.…”