Clinical oxygen transfer performance of the Sorin Monolyth membrane oxygenator

Comparing Oxygen Transfer Performance Between Three Membrane Oxygenators: Effect of Temperature Changes During Cardiopulmonary Bypass

Recently, a new oxygenator (Dideco 903 [D903], Dideco, Mirandola, Italy) has been introduced to the perfusion community, and we set about testing its oxygen transfer performance and then comparing it to two other models. This evaluation was based on the comparison between oxygen transfer slope, gas phase arterial oxygen gradients, degree of blood shunting, maximum oxygen transfer, and diffusing capacity calculated for each membrane. Sixty patients were randomized into three groups of oxygenators (Dideco 703 [D703], Dideco; D903; and Quadrox, Jostra Medizintechnik AG, Hirrlingen, Germany) including 40/20 M/F of 68.6 +/- 11.3 years old, with a body weight of 71.5 +/- 12.1 kg, a body surface area (BSA) of 1.84 +/- 0.3 m(2), and a theoretical blood flow rate (index 2.4 times BSA) of 4.4 +/- 0.7 L/min. The maximum oxygen transfer (VO(2)) values were 313 mL O(2)/min (D703), 579 mL O(2)/min (D903), and 400 mL O(2)/min (Quadrox), with the D903 being the most superior (P < 0.05). Oxygen (O(2)) gradients were 320 mm Hg (D703), 235 mm Hg (D903), and 247 mm Hg (Quadrox), meaning D903 and Quadrox are more efficient versus the D703 (P < 0.05). Shunt fraction (Qs/Qt) and diffusing capacity (DmO(2)) were comparable (P = ns). Diffusing capacity values indexed to BSA (DmO(2)/m(2)) were 0.15 mL O(2)/min/mm Hg/m(2) (D703), 0.2 mL O(2)/min/mm Hg/m(2) (D903), and 0.18 mL O(2)/min/mm Hg/m(2) (Quadrox) with D903 outperforming D703 (P < 0.0005). During hypothermia (32.0 +/- 0.3 degrees C), there was a lower absolute and relative VO(2 )for all three oxygenators (P = ns). The O(2) gradients, DmO(2) and DmO(2)/m(2), were significantly lower for all oxygenators (P < 0.01). Also, Qs/Qt significantly rose for all oxygenators (P < 0.01). The oxygen transfer curve is characteristic to each oxygenator type and represents a tool to quantify oxygenator performance. Using this parameter, we demonstrated significant differences among commercially available oxygenators. However, all three oxygenators are considered to meet the oxygen needs of the patients.

Clinical evaluation of a new generation membrane oxygenator: a prospective randomized study

A new generation hollow-fibre membrane oxygenator (Spiral Gold) has been introduced by Baxter Healthcare (Irvine, CA, USA). The purpose of this study was to evaluate the operational performance of this device under clinical conditions and to compare it to the Univox Gold membrane oxygenator. Following institutional review board approval, and the obtainment of informed consent, 26 patients undergoing coronary artery bypass grafting were randomly assigned to either a Spiral Gold (Spiral) (n = 13) or Univox Gold (Univox) (n = 13) group. Study parameters were grouped into the following categories: haematological, haemodynamic, oxygenator performance and perioperative outcomes. All patients received identical surgical, anaesthesia and postoperative care. There were no statistically significant differences in either preoperative or operative parameters between groups. During cardiopulmonary bypass, the Spiral group had a significantly lower pressure drop (26.9 +/- 8.2 vs 46.7 +/- 16.2 mmHg, p < 0.001). The Spiral group had significantly lower plasma free haemoglobin levels during all time periods of CPB compared to the Univox group. Heat exchange coefficients were higher during the rewarming period in the Spiral patients (0.59 +/- 0.28) compared to the Univox group (0.36 +/- 0.19), p = 0.06. There were no differences in oxygen transfer between groups, but ventilation gas sweep rates and FiO2 levels were statistically lower in the Spiral group at two of the three sampling time periods. The ratio of ventilating gas sweep rate to blood flow rate was lower in the Spiral group (0.56 +/- 0.12) compared to the Univox group (0.74 +/- 0.23), p < 0.03. The Spiral Gold oxygenator had superior oxygen transfer efficiency and lower haemolysis rates than the Univox Gold oxygenator.

Clinical oxygen transfer comparison of the Terumo Capiox SX18 and SX25 membrane oxygenators

The purpose of this current study was to compare the Terumo Capiox SX18 (1.8 m2) with the recently released Capiox SX25 (2.5 m2). Specifically, their oxygen transfer slopes, degree of blood shunting, extrapolated maximum oxygen transfer, blood side pressure drop and oxygen transfer consistency were compared. The lower intercept value (0.209 vs 0.236) coupled with the flatter slope (0.00171 vs 0.00225) of the oxygen transfer line for the SX25 is consistent with improved oxygen transfer performance. A lower FiO2 value would be predicted for the SX25, to achieve a specific PaO2 value, when the oxygen transfer requirement is equal for both devices. Extrapolated maximum oxygen transfer for the SX25 (462.6 ml O2/min) was 36.2% higher than that for the SX18 (339.6 ml O2/min). When indexed to membrane surface area, the SX18 (188.7 ml O2/m2/min performed 2.0% better than the SX25 (185.0 ml O2/m2/min). Both the slope (3.110 vs 3.744) and the intercept (4.595 vs 6.223) of the shunt fraction line were lower for the SX25, indicating that a lower shunt fraction would be predicted for all clinical blood flow rates. The slope (23.934 vs 22.443) and intercept values (-28.388 vs -22.650) of the pressure drop lines for the two devices indicate that the blood side pressure drop, over the range of clinical blood flows, were within 2% of each other. Oxygen transfer consistency, when expressed as the standard deviation of the oxygenator performance index and the percentage of predicted shunt, was not statistically different for the two devices.

Clinical evaluation of the Medtronic Maxima Plus membrane oxygenator

The purpose of this study was to clinically evaluate the degree of improvement, if any, in the oxygen transfer performance of the recently released Medtronic Maxima Plus membrane oxygenator. The outside diameter of the hollow fibres was reduced, increasing the membrane surface area from 2.0 m2 to 2.3 m2 without altering the polycarbonate housing. Maximum extrapolated oxygen transfer of the Maxima Plus (444 ml O2/minute) was increased 23.68% when compared to the Maxima (359 ml O2/minute). When expressed per metre squared of membrane surface area, the Maxima Plus had an increase of 13.5 ml O2/m2/minute (7.24%) over the Maxima. Pressure drop across the Maxima Plus was within 3.5 mmHg of the Maxima over the range of clinical blood flows indicating that the fibre bundle packing density was not significantly altered. Oxygen transfer consistency, expressed as a function of the standard deviation of oxygenator performance index values, was not significantly different for the two oxygenators. We concluded that the improvement in total oxygen transfer was due to an increase in membrane surface area as well as enhanced transfer efficiency per metre squared. We believe that the improved oxygen transfer performance was accomplished without impacting significantly upon the other attributes of the oxygenator (e.g., pressure drop, consistency, priming volume).

Rethinking the AAMI/ISO 'International Standard' for oxygen transfer performance of artificial lungs

We believe we have fulfilled the five objectives outlined in the introductory section to this text. Unquestionably, the clinical perfusionist will be confronted with a set of conditions that do not match the very specific values proposed for our in vitro performance testing. The in vitro results for a particular brand of oxygenator can serve as a 'performance baseline', predicting oxygen transfer performance under standard conditions. It is encumbant upon the clinical perfusionist to assess the impact that each variable (i.e. Hb, blood flow and SvO2) will have on the overall oxygen transfer performance. Table 5 illustrates how increases or decreases in each of these three variables can influence the resulting VO2/minute. The clinical perfusionist must manipulate these variables in order to satisfy the oxygen transfer demand created by the patient on CPB. In order for the in vitro performance testing to be helpful in the clinical environment, the perfusionist must: (1) be familiar with the results and the conditions under which they were achieved; and (2) be able to assess and interpret how their current set of conditions on cardiopulmonary bypass will impact on the oxygenator's performance. Example Brand Y membrane oxygenator is being used clinically on a patient weighing 115 kg and consuming 320 ml O2/minute. According to Table 4, this VO2/minute exceeds the 277.2 ml O2/minute achieved during its in vitro performance test.(ABSTRACT TRUNCATED AT 250 WORDS)