FRAGMIN VS HEPARIN AT RECYCLING OE HUMAN BLOOD IN HEART-LUNG MACHINE (HLM)

During cardio-pulmonary bypass (CPB), Heparin inhibits EXa (EXal), thrombin and platelet activity and is also reported to induce fibrinolysis. Eragmin (Erag) has 25% thrombin inhibition capacity as related to that of Heparin (Hep). An in_vitro study was performed to compare Frag with Hep by circulating blood in a pure artificial system. In 20 experiments, 400 ml of freshly collected blood with Frag or Hep were recycled for 2 h. HLM was primed with 400 ml of Ringeracetate. Blood sampling: donor, blood pack and every 20 min from the oxygenator. V_a£i£ble£/jassay/:ACT/Hemochron/5 APTT , TT and NT/Nyegaard/;FXaI, FVIII and ATIiT t"ATA)/amydolytic/; AT 111 (ATAg) and vWF/IEP/;Plasminogen (Pig) and albumine/immuno-diffusion/;FDP/Wellcome/;Platelet function/Adeplat S/;Fibrinogen (Fbg)/clottable/;Hemolysis (HL)/photometric/; (β -Thromboglobulin ((βTG)/RTA/;EVF, Hb, platelet count (PC) and Leucocyte count (LC)/ conventional). Corrections for hemo-/plasma dilutions were calculated. Dosages (n): Frag: 750 (1), 1500 (3), 2100 (4), 2500 (4) FXal-U (U); Hep: 1000 (3), 1500 (6) IU clinical level. Clotting only occurred at Frag 750 (1) and 1500 (2) U, when ACT, APTT, FVIII, Fbg and ATA were significantly lowered. Generally, PC fell 75% during the recycling, while PF was constant'∼20% and (βTG increased. Neither presence of FDP nor Pig consumption were detected. FXal, ACT, APTT, TT and NT were dose dependent for both drugs. ATA was directly dose-related to Frag but inversely to Hep. LC decreased with the Frag-dose but inversely to that of Hep. HL increased generally. Several proteins increased (clotting excl): Fbg 30%, ATAg 25%, ATA 45?o and vWF 60%. Conclusions. Prevention of clotting required about the double dosage of Frag. Shortened ACT and APTT predicted clotting while the levels of FXal, TT and NT did not. Thus, an effective thrombin inhibition is needed under this conditions. Consumptions of FVIII, Fbg and ATA but no further drop in PC at clotting, indicate weak platelet aggregation involvement. Absence of fibrinolytic signs supports that the fibrinolysis seen at CPB, is not a genuine effect of Hep (or Frag). Increases in some proteins may be caused by cytolysis. The rise in vWF is probably due to release from platelet surfaces.

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Numerical Investigation of Blood Flow Characteristics through Cannulated Aorta

Journal of Biomimetics Biomaterials and Biomedical Engineering ◽

10.4028/www.scientific.net/jbbbe.43.28 ◽

2019 ◽

Vol 43 ◽

pp. 28-38

Author(s):

Dheeman Bhuyan ◽

P. Ramesh Babu ◽

Jyoti Prasad Kalita

Keyword(s):

Blood Flow ◽

Aortic Wall ◽

Flow Characteristics ◽

Physiological Flow ◽

Heart Lung Machine ◽

Flow Through ◽

Cardio Pulmonary Bypass ◽

Pulmonary Bypass ◽

Multiple Morbidities ◽

Lung Machine

Cannulation of the aorta is done in order to provide oxygenation and circulatory function through the use of the heart lung machine during cardio-pulmonary bypass (CPB). The nature of the blood flow through the aorta and its ramifications during CPB is mostly linear as compared to the physiological flow, which is pulsatile in nature. This leads to the development of multiple morbidities caused by the development of emboli and atheromas. Perioperative postoperative care is necessitated by these conditions. As such the understanding of the blood flow characteristics is necessitated in order to effectively prevent the formation of emboli and to prevent the "Sandblasting" effect. The authors in this work seek to investigate the nature of blood flow through the aorta under such circumstances. The results obtained show the nature of blood flow in the cannulated aorta as well as the optimum angle of placement of the cannula with respect to the aortic wall.

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An Automatically Regulated Low Prime Heart-Lung Machine for Infants: A Rabbit Model

Perfusion ◽

10.1177/026765918700200205 ◽

1987 ◽

Vol 2 (2) ◽

pp. 109-113

Author(s):

Erik Wabeke ◽

Piet H Mook ◽

Jan M Elstrodt ◽

Charles RH Wildevuur

Keyword(s):

Cardiopulmonary Bypass ◽

Negative Pressure ◽

Rabbit Model ◽

Gravity Drainage ◽

Extracorporeal Circuit ◽

Donor Blood ◽

Minimal Volume ◽

Priming Volume ◽

Heart Lung Machine ◽

Lung Machine

A new compact heart-lung machine for paediatric use was designed. The total volume of this system of only 90ml allows for priming without the use of donor blood. The priming volume could be kept small mainly by replacing gravity drainage with drainage by a negative pressure in the venous reservoir. To avoid volume shifts between the extracorporeal circuit and the infant's circulation and to safely operate this minimal volume circuit, the heart-lung machine was automatically controlled. In this study we show that the miniaturized system functioned reliably under various conditions during cardiopulmonary bypass in rabbits.

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Cardiac Surgery without Donor Blood Transfusion at a Referral Cardiac Institute in Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i1.42170 ◽

2019 ◽

Vol 5 (1) ◽

pp. 53-58

Author(s):

Kazi Shariful Islam ◽

SAMA Sabur ◽

Kazi Abul Hasan ◽

Begum Marjan Mahal Chowdhury ◽

Nilufar Yasmin ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Cardioplegic Arrest ◽

Donor Blood ◽

Systemic Heparinization ◽

Cardio Pulmonary Bypass ◽

Pulmonary Bypass ◽

Age Range ◽

Written Informed Consent ◽

Calcium Injection

Background: Blood transfusion is always associated with some hazards despite economic and work burden on laboratory staffs. Pre-donation and blood conservation can help to avoid transfusion related hazards with good posto-perative outcome. Objective: The main objective of this study was to show the varieties of cardiac surgery without donor blood transfusion. Methodology: Patients were selected conveniently. Preoperative proper counseling was done to the guardians of minor and all the adult patients about the procedure and written informed consent was taken accordingly. All patients were operated under cardio-pulmonary bypass (CPB) following a standard protocol through mid-sternotomy, systemic heparinization, antegrade intermittent cold cardioplegic arrest of the heart. After weaning from CPB protamine was administered to neutralize the action of heparin. A pre-operative hemoglobin (Hb) and hematocrit (Hct) measured just before systemic heparinization. One bag of blood drawn from the patient’s body when the Hb and Hct more. Meticulous hemostasis done after weaning from cardio-pulmonary bypass. Both systemic and local tranexamic acid plus calcium injection was given before sternal wires are tighten. All the blood in the cardio-pulmonary bypass machine was returned at the end of operation. Patient’s hemoglobin and hematocrit checked to detect the need for transfusion. All other variables were studied. Results: Ten patients were operated without pre-operative blood transfusion of donor blood. Out of ten patients male=5 female=5, Male:Female=1:1 age range 5-26 years mean ±SD (13±-6.88) years. Preop diagnosis ASD 4/10=40%,VSD 3/10=30% TOF 2/10=20% AVR=1/10=10%. pre-operative Hb Range: 12.4-17.3 gm/dl. Mean ±SD (14.25±-1.66 gm/dl. Pre-operative Hct mean±SD (43.7±4.5). Per-operative Hct during CPB Mean±SD (24.9±4). Post-operative Hb mean ±SD (11.25gm±1.18gm). Post-operative Hct mean ±SD (34.3±3.80). Use of cell saver 1/8(12.5%) Post-operative blood loss for ASD,VSD, TOF and AVR were mean ±SD = 140±20.60ml, 156.44±33.84.320.80±60.22ml and 280 ml respectively. Varieties of ionotropes used were: Dopamine Dobutamin Adrenaline. Single ionotrope Dopa/Dobuta5/10=50% Double ionotrope Dopa/dobuta+Adrin=3/10(30%) tripple ionotrope 2/10(20%). Morbidity and mortality 0%. All the patients were discharged home uneventfully, in hospital outcome was good. Conclusion: In our setup we can do cardiac surgery without pre-operative donor blood use by following blood pre-donation and other blood conservative techniques.] Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 53-58

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