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Mlejnsky F, Klein AA, Lindner J, Maruna P, Kvasnicka J, Kvasnicka T, Zima T, Pecha O, Lips M, Rulisek J, Porizka M, Kopecky P, Kunstyr J. A randomised controlled trial of roller versus centrifugal cardiopulmonary bypass pumps in patients undergoing pulmonary endarterectomy. Perfusion 2014; 30:520-8. [DOI: 10.1177/0267659114553283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: There is some controversy as to whether there is a benefit from the use of a centrifugal pump compared with a roller pump during cardiopulmonary bypass to facilitate cardiac surgery. We compared the two pumps, with the primary aim of determining any difference in the effects on inflammation after pulmonary endarterectomy surgery which required prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest. Methods: Between September 2010 and July 2013, 58 elective patients undergoing pulmonary endarterectomy were included in this prospective, randomised, controlled study; 30 patients were randomly allocated to the control group, which used a roller pump, and 28 patients to the treatment group, which used a centrifugal pump. Interleukin-6, procalcitonin, C-reactive protein, thromboelastographic parameters, P-selectin, international normalised ratio, activated prothrombin time, free haemoglobin, haematocrit, red blood cell count, white blood cell count, platelet count and protein S100β were recorded during and after the procedure. We also recorded the length of intensive care unit stay, blood loss and transfusion, neurological outcomes and respiratory and renal failure. Results: There was a significant difference in the primary outcome measure: Interleukin-6 was significantly higher in the roller pump group (587±38 ng·l-1 vs. 327±37 ng·l-1; p<0.001) 24 hours after surgery, which we interpreted as an increased inflammatory response. This was confirmed by a significant rise in the procalcitonin level in the roller pump group 48 hours following surgery (0.79 (0.08-25.25) ng·ml-1 vs. 0.36 (0.02-5.83) ng·ml-1; p<0.05). There were, however, no significant differences in clinical outcome data. Conclusions: We have shown that the use of a centrifugal pump during prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with a reduced inflammatory response compared to the standard roller pump. Larger multi-centre trials in this area of practice are required.
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Affiliation(s)
- F Mlejnsky
- Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, The Czech Republic
| | - A A Klein
- Department of Anaesthesia, Papworth Hospital, Cambridge, UK
| | - J Lindner
- Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, The Czech Republic
| | - P Maruna
- Department of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, The Czech Republic
| | - J Kvasnicka
- Institute for Medical Biochemistry and Laboratory Diagnostics – The Centre for Thrombosis and Haemostasis, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - T Kvasnicka
- Institute for Medical Biochemistry and Laboratory Diagnostics – The Centre for Thrombosis and Haemostasis, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - T Zima
- Institute for Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - O Pecha
- Technology Centre ASCR, Prague, The Czech Republic
| | - M Lips
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - J Rulisek
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - M Porizka
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - P Kopecky
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
| | - J Kunstyr
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic
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Kehara H, Takano T, Ohashi N, Terasaki T, Amano J. Platelet Function During Cardiopulmonary Bypass Using Multiple Electrode Aggregometry: Comparison of Centrifugal and Roller Pumps. Artif Organs 2014; 38:924-30. [DOI: 10.1111/aor.12299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hiromu Kehara
- Department of Cardiovascular Surgery; Shinshu University School of Medicine; Matsumoto Japan
| | - Tamaki Takano
- Department of Cardiovascular Surgery; Shinshu University School of Medicine; Matsumoto Japan
| | - Noburo Ohashi
- Department of Cardiovascular Surgery; Shinshu University School of Medicine; Matsumoto Japan
| | - Takamitsu Terasaki
- Department of Cardiovascular Surgery; Shinshu University School of Medicine; Matsumoto Japan
| | - Jun Amano
- Department of Cardiovascular Surgery; Shinshu University School of Medicine; Matsumoto Japan
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Keyser A, Hilker MK, Diez C, Philipp A, Foltan M, Schmid C. Prospective Randomized Clinical Study of Arterial Pumps Used for Routine on Pump Coronary Bypass Grafting. Artif Organs 2011; 35:534-42. [DOI: 10.1111/j.1525-1594.2010.01120.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Makar M, Taylor J, Zhao M, Farrohi A, Trimming M, D’Attellis N. Perioperative Coagulopathy, Bleeding, and Hemostasis During Cardiac Surgery. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/1944451609357759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac surgery patients use 10%-25% of the blood products transfused annually in the United States. The transfusion of red blood cells or blood products has been the subject of intense scrutiny over the past 10 years. Bleeding after cardiac surgery can be surgical or nonsurgical and lead to hemodynamic compromise and surgical reexploration. Because hemorrhage and blood product transfusions are associated with multiple negative outcomes, including increased mortality, it is prudent to understand the mechanisms responsible for nonsurgical bleeding. This review focuses on the physiology of the normal coagulation and fibrinolysis, risk factors associated with patients presenting for cardiac surgery, impairments of normal hemostasis associated with cardiac surgery and cardiopulmonary bypass (CPB), and potential interventions to reduce perioperative blood loss and blood transfusion.
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Affiliation(s)
- Moody Makar
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jamie Taylor
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Maxnu Zhao
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ali Farrohi
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael Trimming
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicola D’Attellis
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
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Ferraris VA, Ferraris SP, Saha SP, Hessel EA, Haan CK, Royston BD, Bridges CR, Higgins RSD, Despotis G, Brown JR, Spiess BD, Shore-Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83:S27-86. [PMID: 17462454 DOI: 10.1016/j.athoracsur.2007.02.099] [Citation(s) in RCA: 610] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 01/21/2007] [Accepted: 02/08/2007] [Indexed: 01/24/2023]
Abstract
BACKGROUND A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes. METHODS We reviewed all available published evidence related to blood conservation during cardiac operations, including randomized controlled trials, published observational information, and case reports. Conventional methods identified the level of evidence available for each of the blood conservation interventions. After considering the level of evidence, recommendations were made regarding each intervention using the American Heart Association/American College of Cardiology classification scheme. RESULTS Review of published reports identified a high-risk profile associated with increased postoperative blood transfusion. Six variables stand out as important indicators of risk: (1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and (6) noncardiac patient comorbidities. Careful review revealed preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion. Preoperative interventions that are likely to reduce blood transfusion include identification of high-risk patients who should receive all available preoperative and perioperative blood conservation interventions and limitation of antithrombotic drugs. Perioperative blood conservation interventions include use of antifibrinolytic drugs, selective use of off-pump coronary artery bypass graft surgery, routine use of a cell-saving device, and implementation of appropriate transfusion indications. An important intervention is application of a multimodality blood conservation program that is institution based, accepted by all health care providers, and that involves well thought out transfusion algorithms to guide transfusion decisions. CONCLUSIONS Based on available evidence, institution-specific protocols should screen for high-risk patients, as blood conservation interventions are likely to be most productive for this high-risk subset. Available evidence-based blood conservation techniques include (1) drugs that increase preoperative blood volume (eg, erythropoietin) or decrease postoperative bleeding (eg, antifibrinolytics), (2) devices that conserve blood (eg, intraoperative blood salvage and blood sparing interventions), (3) interventions that protect the patient's own blood from the stress of operation (eg, autologous predonation and normovolemic hemodilution), (4) consensus, institution-specific blood transfusion algorithms supplemented with point-of-care testing, and most importantly, (5) a multimodality approach to blood conservation combining all of the above.
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Scott DA, Silbert BS, Doyle TJ, Blyth C, Borton MC, O'brien JL, de L Horne DJ. Centrifugal versus roller head pumps for cardiopulmonary bypass: effect on early neuropsychologic outcomes after coronary artery surgery. J Cardiothorac Vasc Anesth 2002; 16:715-22. [PMID: 12486652 DOI: 10.1053/jcan.2002.128413] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the hypothesis that routine use of a centrifugal pump in the cardiopulmonary bypass circuit would result in a lower incidence of early neuropsychologic deficit when compared with conventional roller pumps. DESIGN Prospective, randomized, double-blind. SETTING University teaching hospital. PARTICIPANTS Patients (n = 103) scheduled for elective coronary artery surgery. INTERVENTIONS Patients were randomized into group C (centrifugal pump for cardiopulmonary bypass; n = 54) and group R (roller pump for cardiopulmonary bypass; n = 49). MEASUREMENTS AND MAIN RESULTS A neuropsychologic test battery of 6 standard tests was administered before surgery and 5 days after surgery. An abnormal test result was defined as deterioration by >1 group SD from an individual's preoperative test performance. There were no significant differences between groups in preoperative or surgical parameters, intensive care unit stay, or hospital stay. There were no significant differences in the incidence of neuropsychologic deficit for patients with a deficit in at least 1 test (group C, 33%; group R, 51%; odds ratio, 0.48; 95% confidence interval, 0.22 to 1.06) or patients with a deficit in >/=2 tests (group C, 6%; group R, 18%; odds ratio, 0.26; 95% confidence interval, 0.07 to 1.03). In group R, there were more individual test deficits per patient than in group C (p = 0.04). CONCLUSION There was no significant difference in the incidence of neuropsychologic deficit postoperatively with routine use of centrifugal pumps. The larger number of individual test deficits in the roller pump group suggest that further studies to assess the potential neuropsychologic benefits of the use of centrifugal pumps are warranted.
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Affiliation(s)
- David A Scott
- Center for Anaesthesia and Cognitive Function, Department of Anaesthesia and Intensive Care, St. Vincent's Hospital, Melbourne, Australia.
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