1
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Ise H, Oyama K, Kunioka S, Shirasaka T, Kanda H, Akhyari P, Kamiya H. Hypothermic circulatory arrest does not induce coagulopathy in vitro. J Artif Organs 2022; 25:314-322. [PMID: 35303203 DOI: 10.1007/s10047-022-01324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
Hypothermic circulatory arrest (HCA) is an essential procedure during aortic surgery to protect organs; however, hypothermia is believed to cause coagulopathy, which is a major fatal complication. This study aimed to clarify the impact of hypothermia on coagulation by eliminating clinical biases in vitro. In the hypothermic storage study, blood samples from five healthy volunteers were stored at 37 ℃ (group N) for 3 h or at 20 ℃ for 2 h, followed by 1 h of rewarming at 37 ℃ (group H). Thromboelastography was performed before and after 3 h of storage. In the mock circulation loop (MCL) study, blood samples were placed in the MCL and (a) maintained at 37 ℃ for 4 h (group N, n = 5), or (b) cooled to 20 ℃ to simulate HCA with a 0.1 L/min flow rate for 3 h and then rewarmed to 37 ℃ (group H, n = 5). The total MCL duration was 4 h, and the flow rate was maintained at 1 L/min, except during HCA. Blood samples collected 15 min after the beginning and end of MCL were subjected to standard laboratory tests and rotational thromboelastometry analyses. Hypothermia had no impact on coagulation in both the hypothermic storage and MCL studies. MCL significantly decreased the platelet counts and clot elasticity in the INTEM and EXTEM assays; however, there was no effect on fibrinogen contribution measured by FIBTEM. Hypothermia does not cause irreversible coagulopathy in vitro; however, MCL decreases coagulation due to the deterioration of platelets.
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Affiliation(s)
- Hayato Ise
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.,Department of Cardiovascular Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Kyohei Oyama
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Payam Akhyari
- Department of Cardiovascular Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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2
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Anastasiadis K, Antonitsis P, Asteriou C, Deliopoulos A, Argiriadou H. Modular minimally invasive extracorporeal circulation ensures perfusion safety and technical feasibility in cardiac surgery; a systematic review of the literature. Perfusion 2021; 37:852-862. [PMID: 34137323 DOI: 10.1177/02676591211026514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Despite extensive evidence that shows clinical of superiority of MiECC, worldwide penetration remains low due to concerns regarding air handling and volume management in the context of a closed system. The purpose of this study is to thoroughly investigate perfusion safety and technical feasibility of performing all cardiac surgical procedures with modular (hybrid) MiECC, as experienced from the perfusionist's perspective. METHODS We retrospectively reviewed perfusion charts of consecutive adult patients undergoing all types of elective, urgent, and emergency cardiac surgery under modular MiECC. The primary outcome measure was perfusion safety and technical feasibility, as evidenced in the need for conversion from a closed to an open circuit. A systematic review of the literature was conducted aiming to ultimately clarify whether there are any safety issues regarding MiECC technology. RESULTS We challenged modular MiECC use in a series of 403 consecutive patients of whom a significant proportion (111/403; 28%) underwent complex surgery including reoperations (4%), emergency repair of acute type A aortic dissection and composite aortic surgery (1.7%). Technical success rate was 100%. Conversion to an open circuit was required in 18/396 patients (4.5%), excluding procedures performed under circulatory arrest. Open configuration accounted for 40% ± 21% of total procedural perfusion time and was related to significant hemodilution and increase in peak lactate levels. Systematic review revealed that safety of the procedure challenged originated from a single report, while no clinical adverse event related to MiECC was identified. CONCLUSIONS Use of modular MiECC secures safety and ensures technical feasibility in all cardiac surgical procedures. It represents a type III active closed system, while its stand-by component is reserved for a small (<5%) proportion of procedures and for a partial procedural time. Thus, it eliminates any safety concern regarding air handling and volume management, while it overcomes any unexpected intraoperative scenario.
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Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Asteriou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Deliopoulos
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Helena Argiriadou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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3
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Harea GT, Karaliou V, Roberts TR, Choi JH, Beely BM, Cancio LC, Batchinsky AI. Dynamics of appearance and decay of gaseous microemboli during in vitro extracorporeal circulation. Perfusion 2021; 37:242-248. [PMID: 33567967 DOI: 10.1177/0267659121991423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal life support (ECLS) patients are at risk for complications caused by gaseous microemboli (GME). GMEs can cause hypoxia, inflammation, coagulation, and end-organ damage. The objective of this in vitro study was to assess dynamics of GME formation during circulation of whole blood or a glycerol blood surrogate. We hypothesized that there is no difference in GME counts and sizes between whole blood and the glycerol blood surrogate and that the membrane lung reduces GME counts over time. METHODS A circulation platform was developed using the Cardiohelp ECLS system to run either donor blood or glycerol solution. We conducted 10 repetitions consisting of three phases of ultrasound GME detection using the EDAC™ Quantifier (Luna Innovations, Charlottesville, VA, USA) for each group. Phases were 3-minute recordings at the initiation of 2 L/min flow (Phase 1), post-injection of a GME suspension (Phase 2), and 10 minutes after injection (Phase 3). The number and size of GME pre- and post-ML were recorded separately and binned based on diameter ranges. RESULTS In Phase 1, GME count in blood was higher than in glycerol. In Phase 2, there was a large increase in GME counts; however, most GME were reduced post-membrane in both groups. In Phase 3, there was a significant decrease in GME counts compared to Phase 2. GME > 100 μm in glycerol decreased post membrane. CONCLUSIONS We demonstrated GME formation and decay dynamics during in vitro circulation in an ECLS system with blood and glycerol. GME counts were higher in blood, likely due to varying rheological properties. There were decreases in GME levels post membrane in both groups after GME injection, with the membrane lung effectively trapping the GME, and additional reduction 10 minutes after GME injection.
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Affiliation(s)
- George T Harea
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA.,The Geneva Foundation, Tacoma, WA, USA
| | - Vitali Karaliou
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA.,The Geneva Foundation, Tacoma, WA, USA
| | - Teryn R Roberts
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA.,The Geneva Foundation, Tacoma, WA, USA.,Department of Translational Medicine, University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, TX, USA
| | - Jae-Hyek Choi
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA.,The Geneva Foundation, Tacoma, WA, USA.,Department of Translational Medicine, University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, TX, USA
| | - Brendan M Beely
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA.,The Geneva Foundation, Tacoma, WA, USA.,Department of Translational Medicine, University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, TX, USA
| | | | - Andriy I Batchinsky
- Autonomous Reanimation and Evacuation Research Program, San Antonio, TX, USA.,The Geneva Foundation, Tacoma, WA, USA.,Department of Translational Medicine, University of the Incarnate Word, School of Osteopathic Medicine, San Antonio, TX, USA.,U.S. Army Institute of Surgical Research, San Antonio, TX, USA
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Ganushchak YM, Körver EP, Maessen JG. Is there a "safe" suction pressure in the venous line of extracorporeal circulation system? Perfusion 2020; 35:521-528. [PMID: 32627671 PMCID: PMC7416326 DOI: 10.1177/0267659120936453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Successes of extracorporeal life support increased the use of centrifugal pumps.
However, reports of hemolysis call for caution in using these pumps, especially
in neonatology and in pediatric intensive care. Cavitation can be a cause of
blood damage. The aim of our study was to obtain information about the
cavitation conditions and to provide the safest operating range of centrifugal
pumps. A series of tests were undertaken to determine the points at which pump
performance decreases 3% and gas bubbles start to appear downstream of the pump.
Two pumps were tested; pump R with a closed impeller and pump S with a semiopen
impeller. The performance tests demonstrated that pump S has an optimal region
narrower than pump R and it is shifted to the higher flows. When the pump
performance started to decrease, the inlet pressure varies but close to
−150 mmHg in the test with low gas content and higher than −100 mmHg in the
tests with increased gas content. The same trend was observed at the points of
development of massive gas emboli. Importantly, small packages of bubbles
downstream of the pump were registered at relatively high inlet pressures. The
gaseous cavitation in centrifugal pumps is a phenomenon that appears with
decreasing inlet pump pressures. There are a few ways to increase inlet pump
pressures: (1) positioning the pump as low as possible in relation to the
patient; (2) selecting appropriate sized venous cannulas and their careful
positioning; and (3) controlling patient’s volume status.
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Affiliation(s)
- Yuri M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erik Pj Körver
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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Van Poucke S, Stevens K, Kicken C, Simons A, Marcus A, Lancé M. Platelet Function During Hypothermia in Experimental Mock Circulation. Artif Organs 2015; 40:288-93. [DOI: 10.1111/aor.12555] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sven Van Poucke
- Department of Anesthesiology, Emergency Medicine, Critical Care & Multidisciplinary Pain Centre; Ziekenhuis Oost-Limburg; Genk Belgium
| | - Kris Stevens
- Department of Anesthesiology; Maastricht University; Maastricht The Netherlands
| | - Cécile Kicken
- Department of Anesthesiology; Maastricht University; Maastricht The Netherlands
| | - Antoine Simons
- Department of Cardiovascular Research Institute; Maastricht University; Maastricht The Netherlands
| | - Abraham Marcus
- Anesthesiology, ICU and Perioperative Medicine; HMC; Doha Qatar
| | - Marcus Lancé
- Department of Anesthesiology; Maastricht University; Maastricht The Netherlands
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Ganushchak YM, Körver EPJ, Yamamoto Y, Weerwind PW. Versatile minimized system--a step towards safe perfusion. Perfusion 2015; 31:295-9. [PMID: 26354746 DOI: 10.1177/0267659115604711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A growing body of evidence indicates the superiority of minimized cardiopulmonary bypass (CPB) systems compared to conventional systems in terms of inflammatory reactions and transfusion requirements. Evident benefits of minimized CPB systems, however, do not come without consequences. Kinetic-assisted drainage, as used in these circuits, can result in severe fluctuations of venous line pressures and, consequently, fluctuation of the blood flow delivered to the patient. Furthermore, subatmospheric venous line pressures can cause gaseous microemboli. Another limitation is the absence of cardiotomy suction, which can lead to excessive blood loss via a cell saver. The most serious limitation of minimized circuits is that these circuits are very constrained in the case of complications or changing of the surgery plan. We developed a versatile minimized system (VMS) with a priming volume of about 600 ml. A compliance chamber in the venous line decreases peaks of pressure fluctuations. This chamber also acts as a bubble trap. Additionally, the open venous reservoir is connected parallel to the venous line and excluded from the circulation during an uncomplicated CPB. This reservoir can be included in the circulation via a roller pump and be used as a cardiotomy reservoir. The amount and rate of returned blood in the circulation is regulated by a movable level detector. Further, the circuit can easily be converted to an open system with vacuum-assisted venous drainage in the case of unexpected complications. The VMS combines the benefits of minimized circuits with the versatility and safety of a conventional CPB system. Perfusionists familiar with this system can secure an adequate and timely response at expected and unexpected intraoperative complications.
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Affiliation(s)
- Y M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - E P J Körver
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Y Yamamoto
- Department of Clinical Engineering, Anjo Kosei Hospital, Anjo, Japan
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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7
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Aboud A, Mederos-Dahms H, Liebing K, Zittermann A, Schubert H, Murray E, Renner A, Gummert J, Börgermann J. Counteracting negative venous line pressures to avoid arterial air bubbles: an experimental study comparing two different types of miniaturized extracorporeal perfusion systems. BMC Anesthesiol 2015; 15:81. [PMID: 26021999 PMCID: PMC4459480 DOI: 10.1186/s12871-015-0058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 05/19/2015] [Indexed: 12/05/2022] Open
Abstract
Background Because of its low rate of clinical complications, miniaturized extracorporeal perfusion systems (MEPS) are frequently used in heart centers worldwide. However, many recent studies refer to the higher probability of gaseous microemboli formation by MEPS, caused by subzero pressure values. This is the main reason why various de-airing devices were developed for today’s perfusion systems. In the present study, we investigated the potential benefits of a simple one-way-valve connected to a volume replacement reservoir (OVR) for volume and pressure compensation. Methods In an experimental study on 26 pigs, we compared MEPS (n = 13) with MEPS plus OVR (n = 13). Except OVR, perfusion equipment was identical in both groups. Primary endpoints were pressure values in the venous line and the right atrium as well as the number and volume of air bubbles. Secondary endpoints were biochemical parameters of systemic inflammatory response, ischemia, hemodilution and hemolysis. Results One animal was lost in the MEPS + OVR group. In the MEPS + OVR group no pressure values below −150 mmHg in the venous line and no values under -100 mmHg in right atrium were noticed. On the contrary, nearly 20 % of venous pressure values in the MEPS group were below −150 and approximately 10 % of right atrial pressure values were below -100 mmHg. Compared with the MEPS group, the bubble counter device showed lower numbers of arterial air bubbles in the MEPS + OVR group (mean ± SD: 13444 ± 5709 vs. 1 ± 2, respectively; p < 0.001). In addition, bubble volume was significantly lower in the MEPS + OVR group than in the MEPS group (mean ± SD: 1522 ± 654 μl vs. 4 ± 6 μl, respectively; p < 0.001). The proinflammatory cytokine interleukin-6 and biochemical indices of cardiac ischemia (creatine kinase, and troponin I) were comparable between both groups. Conclusions The use of a miniaturized perfusion system with a volume replacement reservoir is able to counteract excessive negative venous line pressures and to reduce the number and volume of arterial air bubbles. This approach may lead to a lower rate of neurological complications.
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Affiliation(s)
- Anas Aboud
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| | - Hendrikje Mederos-Dahms
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| | - Kai Liebing
- Department of Medical Technology, Friedrich Schiller University, Jena, Germany.
| | - Armin Zittermann
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| | - Harald Schubert
- Institute of Laboratory Animal Science and Welfare, Friedrich Schiller University, Jena, Germany.
| | - Edward Murray
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| | - Andre Renner
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
| | - Jochen Börgermann
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
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Ganushchak YM, Simons AP, Weerwind PW. The hidden limitations in "advertising" a novel synchronized cardiac assist device. Artif Organs 2015; 39:451-2. [PMID: 25953235 DOI: 10.1111/aor.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yuri M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Antoine P Simons
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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9
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Anastasiadis K, Antonitsis P, Argiriadou H, Deliopoulos A, Grosomanidis V, Tossios P. Modular minimally invasive extracorporeal circulation systems; can they become the standard practice for performing cardiac surgery? Perfusion 2015; 30:195-200. [DOI: 10.1177/0267659114567555] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally invasive extracorporeal circulation (MiECC) has been developed in an attempt to integrate all advances in cardiopulmonary bypass technology in one closed circuit that shows improved biocompatibility and minimizes the systemic detrimental effects of CPB. Despite well-evidenced clinical advantages, penetration of MiECC technology into clinical practice is hampered by concerns raised by perfusionists and surgeons regarding air handling together with blood and volume management during CPB. We designed a modular MiECC circuit, bearing an accessory circuit for immediate transition to an open system that can be used in every adult cardiac surgical procedure, offering enhanced safety features. We challenged this modular circuit in a series of 50 consecutive patients. Our results showed that the modular AHEPA circuit design offers 100% technical success rate in a cohort of random, high-risk patients who underwent complex procedures, including reoperation and valve and aortic surgery, together with emergency cases. This pilot study applies to the real world and prompts for further evaluation of modular MiECC systems through multicentre trials.
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Affiliation(s)
- K Anastasiadis
- Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - P Antonitsis
- Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - H Argiriadou
- Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - A Deliopoulos
- Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - V Grosomanidis
- Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - P Tossios
- Cardiothoracic Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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10
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Simons AP, Martens EGHJ, Ganushchak YM, Weerwind PW. Centrifugal pump performance during low-flow extracorporeal CO2 removal; safety considerations. Perfusion 2014; 30:17-23. [PMID: 24919405 DOI: 10.1177/0267659114540024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to examine the hydrodynamic performance and gaseous microemboli (GME) activity of two centrifugal pumps for possible use in low-flow extracorporeal CO2 removal. MATERIALS & METHODS The performance of a Rotassist 2.8 and a Rotaflow 32 centrifugal pump (Maquet Cardiopulmonary AG, Hirrlingen, Germany) was evaluated in a water-glycerine mixture-filled in vitro circuit that enabled measurement of pressures and GME at the pump inlet and pump outlet. Pressure-flow curves were acquired in a 1,000 to 5,000 rpm range while increasing drainage resistance in one series and outlet resistance in another. RESULTS Respective minimum pump inlet and maximum pump outlet pressures were -539 mmHg and 754 mmHg for the Rotassist 2.8 and -606 mmHg and 806 mmHg for the Rotaflow 32. Maximum standard deviations on pump pressures and flow amounted to 3.0 mmHg and 0.03 L/min, respectively, regardless of pump type and drainage or outlet resistance. The GME at the pump outlet were detectable at pump inlet pressures below -156 mmHg at 0.2 L/min and 2,500 rpm for the Rotassist 2.8 and below -224 mmHg at 0.9 L/min and 3,000 rpm for the Rotaflow 32. CONCLUSION Both the Rotassist 2.8 and Rotaflow 32 centrifugal pumps show a comparably high hydrodynamic stability, but potential GME formation with decreasing pump inlet pressures should be taken into account to ensure safe centrifugal pump-based low-flow extracorporeal CO2 removal.
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Affiliation(s)
- A P Simons
- Deptartment of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - E G H J Martens
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Y M Ganushchak
- Deptartment of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - P W Weerwind
- Deptartment of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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11
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Simons AP, Weerwind PW. A volume buffer capacity device dynamically reduces excessive venous line pressure and arterial gaseous embolic load during minimized cardiopulmonary bypass. Eur J Cardiothorac Surg 2014; 47:391. [PMID: 24771755 DOI: 10.1093/ejcts/ezu180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antoine P Simons
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, Netherlands
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, Netherlands
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12
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Aboud A, Liebing K, Hakim-Meibodi K, Börgermann J. Reply to Simons and Weerwind. Eur J Cardiothorac Surg 2014; 47:391-2. [PMID: 24771756 DOI: 10.1093/ejcts/ezu181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anas Aboud
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kai Liebing
- Medical Technology, Friedrich Schiller University, Jena, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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13
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Simons AP, Lindelauf AAMA, Ganushchak YM, Maessen JG, Weerwind PW. Efficacy and safety of strategies to preserve stable extracorporeal life support flow during simulated hypovolemia. Perfusion 2013; 29:18-24. [DOI: 10.1177/0267659113502833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: Without volume-buffering capacity in extracorporeal life support (ELS) systems, hypovolemia can acutely reduce support flow. This study aims at evaluating efficacy and safety of strategies for preserving stable ELS during hypovolemia. Material & Methods: Flow and/or pressure-guided servo pump control, a reserve-driven control strategy and a volume buffer capacity (VBC) device were evaluated with respect to pump flow, venous line pressure and arterial gaseous microemboli (GME) during simulated normovolemia and hypovolemia. Results: Normovolemia resulted in a GME-free pump flow of 3.1±0.0 L/min and a venous line pressure of −10±1 mmHg. Hypovolemia without servo pump control resulted in a GME-loaded flow of 2.3±0.4 L/min with a venous line pressure of −114±52 mmHg. Servo control resulted in an unstable and GME-loaded flow of 1.5±1.2 L/min. With and without servo pump control, the VBC device stabilised flow (SD = 0.2 and 0.0 L/min, respectively) and venous line pressure (SD=51 and 4 mmHg, respectively) with near-absent GME activity. Reserve-driven pump control combined with a VBC device restored a near GME-free flow of 2.7±0.0 L/min with a venous line pressure of −9±0 mmHg. Conclusion: In contrast to a reserve-driven pump control strategy combined with a VBC device, flow and pressure servo control for ELS show evident deficits in preserving stable and safe ELS flow during hypovolemia.
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Affiliation(s)
- AP Simons
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - AAMA Lindelauf
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - YM Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - JG Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - PW Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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Simons AP, Ganushchak YM, Teerenstra S, Bergmans DC, Maessen JG, Weerwind PW. Hypovolemia in extracorporeal life support can lead to arterial gaseous microemboli. Artif Organs 2013; 37:276-82. [PMID: 23419147 DOI: 10.1111/j.1525-1594.2012.01560.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Next to severely decreased pump flow, hypovolemia in extracorporeal life support (ELS) can result in subatmospheric venous line pressure. Such pressure may lead to degassing and resultant gaseous microemboli (GME), with potential changes in neurological clinical outcome. CME activity resulting from degassing was investigated in relation to subatmospheric venous line pressure, partial oxygen pressure (pO2 ), and hematocrit in a model of a centrifugal pump-based circuit for long-term ELS. Additionally, a device that provides instantaneous volume buffer capacity during hypovolemia was evaluated in relation to GME appearance. An exponential relationship was found between decreasing venous line pressure and GME downstream of the centrifugal pump (P = 0.001). Arterial bubble activity appeared at subatmospheric venous line pressures of -200 mm Hg and less. A rising (pO2 ) increased formation of GME (P = 0.05). A rise in hematocrit, in contrast, did not affect embolic activity (P = 0.22). With simulated hypovolemia, volume buffer capacity added to the venous line dampened fluctuations of venous line pressure by approximately 40%, but a significant reduction in GME formation could not be found (P = 0.22). Moreover, the device enabled a 14% higher support flow. With ELS flow being related to patient volume status, hypovolemia can diminish support. A coherent decrease of venous line pressure triggers degassing of blood-dissolved gases and causes arterial GME, which can become massive during persistent conditions of limited venous return. Incorporation of a volume buffer capacity device into the extracorporeal support circuit enables a higher and more stable support flow in critically low patient filling.
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Affiliation(s)
- Antoine P Simons
- Department of Cardiothoracic Surgery and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, Maastricht, The Netherlands.
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