A clinical evaluation of platelet function, haemolysis and oxygen transfer during cardiopulmonary bypass comparing the Quantum HF-6700 to the HF-5700 hollow fibre membrane oxygenator

Perfusion ◽  
2000 ◽  
Vol 15 (6) ◽  
pp. 479-484 ◽  
Author(s):  
A O Chukwuemeka ◽  
M RJ Turtle ◽  
U H Trivedi ◽  
G E Venn ◽  
D J Chambers
Keyword(s):  
Cardiopulmonary Bypass ◽  
Platelet Function ◽  
Clinical Evaluation ◽  
Oxygen Transfer ◽  
Artery Bypass ◽  
Membrane Surface ◽  
Platelet Activating Factor ◽  
Hollow Fibre ◽  
Priming Volume ◽  
First Time

The continued improvement of oxygenators is an important aspect of patient safety during cardiopulmonary bypass (CPB). The purpose of this study was to compare the Bard William Harvey HF-5700 oxygenator to the upgraded Bard Quantum HF-6700, which has recently been introduced into clinical practice. No clinical evaluation of this device has been published to date. The two oxygenators differ principally in that the Quantum has a smaller priming volume, achieved at the expense of a smaller membrane surface area which could result in sub-optimal gas exchange characteristics, increased haemolysis and increased platelet dysfunction during CPB. Twenty adult patients undergoing elective, first time coronary artery bypass grafting (CABG) were randomly assigned either to the HF-5700 ( n=10) or to the HF-6700 ( n=10) group. One patient underwent mitral valve repair in addition to CABG and was excluded from further study. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Samples were obtained at the start of CPB, at 30 min, 60 min, at the end of CPB and at 1 h following termination of CPB. No significant differences between the two groups were found in oxygen transfer, haemolysis (plasma haptoglobin levels) or platelet function (a novel platelet activating factor (PAF)-induced platelet activation test) at any of the time points during CPB. It was concluded that the Quantum HF-6700 matches the HF-5700 for the parameters studied, whilst having the advantage of requiring a smaller priming volume.

Evaluation of coated oxygenators in cardiopulmonary bypass systems and their impact on neurocognitive function

Perfusion ◽  
2005 ◽  
Vol 20 (5) ◽  
pp. 249-254 ◽  
Author(s):  
Amir Khosravi ◽  
Christian A Skrabal ◽  
Bernd Westphal ◽  
Guenther Kundt ◽  
Brigitte Greim ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Neurocognitive Function ◽  
Hollow Fibre ◽  
Protective Effects ◽  
Neurocognitive Functions ◽  
Group A ◽  
Group B

Introduction: Coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass (CPB) is assumed to be associated with a decline of neurocognitive functions. This study was designed to analyse the neurocognitive function of patients with coronary heart disease before and after CABG and to determine possible protective effects of oxygenator surface coating on neurological outcome. Methods: Forty patients scheduled for selective CABG were prospectively randomized into two groups of 20 patients each according to the type of hollow-fibre membrane oxygenator used. Non-coated oxygenators (Group A) were compared to phosphorylcholine (PC)- coated oxygenators (Group B). A battery of six neurological tests was administered preoperatively, 7 - 10 days and 4 - 6 months after surgery. Results: One patient of Group A suffered from a perioperative stroke and died on postoperative day 3, presumably because of sudden heart failure. Two patients of Group A (10%) developed a symptomatic transitory delirious psychotic syndrome (STPT) on postoperative days 3 and 5. None of the patients of Group B had perioperative complications. The test analysis revealed a trend of declined neurocognitive function early after CABG, but did not show any difference in neurocognitive outcome between the two groups. Discussion: PC coating of the oxygenators did not show any significant benefit on neurocognitive function after CABG using CPB.

Clinical evaluation of the Medtronic Maxima Plus membrane oxygenator

Perfusion ◽  
1994 ◽  
Vol 9 (5) ◽  
pp. 363-372 ◽  
Author(s):  
David W Fried ◽  
Benjamin N DeBenedetto ◽  
Theodore L Zombolas ◽  
Joseph J Leo
Keyword(s):  
Pressure Drop ◽  
Surface Area ◽  
Oxygen Transfer ◽  
Membrane Surface ◽  
Transfer Performance ◽  
Membrane Oxygenator ◽  
Membrane Surface Area ◽  
Blood Flows ◽  
Priming Volume ◽  
Outside Diameter

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).

scholarly journals Clinical evaluation of the Admiral 1.35m2 hollow-fibre membrane oxygenator

Perfusion ◽  
2008 ◽  
Vol 23 (1) ◽  
pp. 33-38 ◽  
Author(s):  
R Issitt ◽  
T Cumberland ◽  
A Clements ◽  
J Mulholland
Keyword(s):  
Surface Area ◽  
Clinical Performance ◽  
Artery Bypass ◽  
Hollow Fibre ◽  
Current Standard ◽  
Small Surface ◽  
Pressure Drops ◽  
Standard Data ◽  
Priming Volume ◽  
And Performance

This prospective study was designed to evaluate the fundamental clinical performance of a new, small surface area oxygenator. Data were collected from twenty patients undergoing first-time coronary artery bypass grafting using this device. This study focuses on how the reduction of surface area and prime volume affects the essential function of the oxygenator in terms of oxygenation efficiency, heat transference, membrane pressure drops, haemolysis and safety. Oxygenation efficiency was deemed to be well within acceptable margins, even at high flows, over a temperature range of 32-36°C. Heat-exchanger performance was assessed by recording the heater/chiller water temperature compared to retrospective data from a current standard oxygenator. Heater/chiller water temperatures were on average 0.3°C higher with the small surface oxygenator than the standard data. The air handling of the device was excellent and extremely safe. Haemolysis, measured as plasma free haemoglobin, did not increase during bypass (p>0.05). This new oxygenator offers a reduced surface area and priming volume while still ensuring an acceptable safety reserve and performance.

scholarly journals Effect of Cardiopulmonary Bypass Machine on the Platelet Function Testing.

2020 ◽  
Author(s):  
Khalid A. AlSaleh ◽  
Rashed B. AlBakr ◽  
Turki B. AlBacker ◽  
Rakan AlNazer ◽  
Abdulkareem Almomen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Platelet Function ◽  
Clinical Decision Making ◽  
Complete Blood Count ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Inverse Correlation ◽  
Platelet Dysfunction ◽  
Significant Difference

Abstract Background: Bleeding during coronary artery bypass surgery is a leading cause of mortality. Several factors have been associated with bleeding, platelet dysfunction being the most significant.Objective: to assess the effect of cardiopulmonary bypass machine (CPB) during cardiac surgery on platelet function using Platelet Function Analyzers (PFA-100), and Multiplate Electrode Aggregometry (MEA), and correlating that with a drop in Hemoglobin (Hb).Methods: Whole blood samples were collected preoperative and sixty minutes intraoperatively of different cardiac procedures utilizing (CPB) and tested for platelet function by PFA-100 and MEA. Complete blood count was measured using an automated hematology analyzer.Results: A significant difference was found between pre- and intraoperative ADP and EPI measurement in PFA-100, where preoperative PFA-ADP values displayed the ability to predict the intra-op drop in Hb (P–value 0.01, correlation coefficient 0.4699). At the same time, pre-op MEA- Ristocetin and TRAP showed an inverse correlation with an intra-op drop in Hb (-0.31 and -0.36). Conclusion: The current study reported significant changes in platelet dysfunction in cardiac surgeries with CPB, measured by two modalities PFA-100, and MEA. While PFA-100 and MEA both detected the changes in platelet dysfunction due to CPB, PFA-100 results were sensitive and positively predicted intra-op Hb drop as compared to MEA. There was a significant change in Hb one hour into the CPB, indicating that platelet transfusion might help decrease Intra- and postoperative bleeding independent of the platelet count as they are dysfunctional. PFA-100 results can be relied upon for distinction of high-risk cardiac surgery patients for bleeding and can be used for clinical decision making to improve patient outcome.

Alterations Of Hemostasis During Cardiopulmonary Bypass (CPB): A Comparison Between Membrane And Bubble Oxygenators

1981 ◽  
Author(s):  
R L Bick ◽  
N R Arbegast ◽  
W R Schmalhorst
Keyword(s):  
Cardiopulmonary Bypass ◽  
Platelet Function ◽  
Coronary Artery Bypass Surgery ◽  
Degradation Products ◽  
Artery Bypass ◽  
Membrane System ◽  
Platelet Dysfunction ◽  
Significant Correction ◽  
Function Defect ◽  
Membrane Oxygenators

Alterations of hemostasis during cardiopulmonary bypass (CPB) using bubble oxygenators have been previously defined and found to consist of a severe platelet function defect, a primary hyperfibrino(geno)lytic syndrome, and minimal thrombocytopenia. This study compares defects in hemostasis with membrane oxygenators and bubble oxygenators. 30 consecutive patients were studied and all patients studied were undergoing elective coronary artery bypass surgery. Tests of hemostasis included thrombin and reptilase times, protamine corrected thrombin times, soluble fibrin monomer, fibrinogen degradation products, fibrinolytic assays, platelet counts, and tests of platelet function. Studies were drawn pre-bypass, mid-bypass, and 1 hour post bypass. It was found that thrombocytopenia was much less in membrane patients. All patients developed a primary hyperfibrino(geno)lytic syndrome and the degree of this was equal in bubble or membrane oxygenators. Platelet dysfunction also was seen in all patients but was significantly different between the two oxygenation systems. At one hour postop, membrane patients showed no correction of platelet function as assessed by adhesion (14%), while those perfused with bubble oxygenators showed significant correction (67%) at one hour postop.In conclusion, the primary hyperfibrino(geno)lytic syndrome occurring during cardiopulmonary bypass appears to be of equal significance regardless of oxygenation mechanism. Less thrombocytopenia, but more platelet dysfunction is seen with the membrane system.

Clinical evaluation of the Bentley Univox membrane oxygenator

Perfusion ◽  
1992 ◽  
Vol 7 (1) ◽  
pp. 59-65 ◽  
Author(s):  
J. Nowak ◽  
G. Pols ◽  
W. Brands ◽  
P. Rosseel
Keyword(s):  
Heat Exchange ◽  
Clinical Evaluation ◽  
Coronary Artery Bypass Surgery ◽  
Artery Bypass ◽  
Membrane Oxygenator ◽  
Polypropylene Fibres ◽  
New Device ◽  
Exchange Performance ◽  
Priming Volume ◽  
Base Management

This paper reports a clinical evaluation of Bentley's new Univox membrane oxygenator (Bentley Laboratories, Irvine, California). In this new device, the blood flow path is outside the fibre, the incorporated heat exchanger consists of a 22-channel stainless-steel bellows, and the polypropylene fibres are woven into fibre ribbons and wound into each of the bellows channels. In this way, heat and gas transfers take place simultaneously. The priming volume has been reduced to 220ml and the membrane has an effective surface area of 1.6m2. A BMR 1900 collapsible reservoir (Bentley Laboratories, Irvine, California) was used as a venous reservoir. Ten consenting patients undergoing elective coronary artery bypass surgery were perfused with this new oxygenator. BSA was between 1.7 and 2.11 m 2; mean BSA was 1.81. Minimum priming was 1200ml. The blood-gas results were all within or close to the normal range used in our institution. Acid-base management was performed using alpha-stat regulation and no problems occurred in this series of patients. Average pO2 was 155mmHg±53 with a mean O2 transfer of 90.7ml and a maximum of 185ml. The heat exchange performance was very good, with a mean coefficient of heat exchange of 0.54±0.11 and a maximum of 0.87.

An assessment of oxygen transfer efficiency in a gas permeable hollow fibre membrane biological reactor

2010 ◽  
Vol 61 (5) ◽  
pp. 1165-1171 ◽  
Author(s):  
G. Soreanu ◽  
L. Lishman ◽  
S. Dunlop ◽  
H. Behmann ◽  
P. Seto
Keyword(s):  
Mass Transfer ◽  
Chemical Reaction ◽  
Oxygen Transfer ◽  
Membrane Surface ◽  
Treatment Plant ◽  
Hollow Fibre ◽  
Transfer Efficiency ◽  
Fine Bubble ◽  
Oxygen Transfer Efficiency ◽  
Bubble Diffusers

The clean water oxygen transfer efficiency (OTE) of a full scale non-porous hollow fibre gas permeable (GP) membrane (surface area of 500 m2) was evaluated at inlet air pressures of 1.2, 1.4, and 1.8 atm using two established testing methods. To form a basis of comparison with traditional aeration technologies, additional testing was done with conventional aerators (fine bubble and coarse bubble diffusers) replacing the GP membrane. OTE can be established based on the re-aeration of deoxygenated water or by monitoring the catalytic oxidation of a sodium sulphite (Na2SO3) solution. In this study, OTE values determined by sulphite oxidation (SOTES) were consistently higher than those established during re-aeration (SOTER) suggesting that the chemical reaction was enhancing the mass transfer. The chemical reaction was sufficiently fast in the case of the GP membrane, that the gas phase limited the mass transfer. The GP membrane operating at 1.2 atm had a SOTES of 70.6% and a SOTER of 52.2%. SOTER for the coarse bubble and fine bubble diffusers were 3.8% and 23.6%, respectively. This is comparable to the manufacturer's values, corrected for depth of 3.4% and 18.3%, respectively. Particularly, the derived OTE values were used to evaluate differences in energy consumption for a conventional treatment plant achieving carbon removal and nitrification. This analysis highlights the potential energy efficiency of GP membranes, which could be considered for the design of the membrane modules.

Prediction of Prolonged Ventilation after Coronary Artery Bypass Grafting: Data from an Artificial Neural Network

2017 ◽  
Vol 20 (1) ◽  
pp. 007 ◽  
Author(s):  
Eric Stephen Wise ◽  
David P. Stonko ◽  
Zachary A. Glaser ◽  
Kelly L. Garcia ◽  
Jennifer J. Huang ◽  
...  
Keyword(s):  
Neural Network ◽  
Mechanical Ventilation ◽  
Artificial Neural Network ◽  
Logistic Regression ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Early Identification ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Prolonged Ventilation

Objectives: The need for mechanical ventilation 24 hours after coronary artery bypass grafting (CABG) is considered a morbidity by the Society of Thoracic Surgeons. The purpose of this investigation was twofold: to identify simple preoperative patient factors independently associated with prolonged ventilation and to optimize prediction and early identification of patients prone to prolonged ventilation using an artificial neural network (ANN).Methods: Using the institutional Adult Cardiac Database, 738 patients who underwent CABG since 2005 were reviewed for preoperative factors independently associated with prolonged postoperative ventilation. Prediction of prolonged ventilation from the identified variables was modeled using both “traditional” multiple logistic regression and an ANN. The two models were compared using Pearson r2 and area under the curve (AUC) parameters.Results: Of 738 included patients, 14% (104/738) required mechanical ventilation ≥ 24 hours postoperatively. Upon multivariate analysis, higher body-mass index (BMI; odds ratio [OR] 1.10 per unit, P < 0.001), lower ejection fraction (OR 0.97 per %, P = 0.01) and use of cardiopulmonary bypass (OR 2.59, P = 0.02) were independently predictive of prolonged ventilation. The Pearson r2 and AUC of the multivariate nominal logistic regression model were 0.086 and 0.698 ± 0.05, respectively; analogous statistics of the ANN model were 0.159 and 0.732 ± 0.05, respectively.BMI, ejection fraction and cardiopulmonary bypass represent three simple factors that may predict prolonged ventilation after CABG. Early identification of these patients can be optimized using an ANN, an emerging paradigm for clinical outcomes modeling that may consider complex relationships among these variables.

Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting

2016 ◽  
Vol 19 (6) ◽  
pp. 289 ◽  
Author(s):  
Mehmet Yilmaz ◽  
Rezan Aksoy ◽  
Vildan Kilic Yilmaz ◽  
Canan Balci ◽  
Cagri Duzyol ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Urine Output ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Urinary Output ◽  
Bypass Grafting

Objective: This study evaluated the relationship between the amount of urinary output during cardiopulmonary bypass and acute kidney injury in the postoperative period of coronary artery bypass grafting.Methods: Two hundred patients with normal preoperative serum creatinine levels, operated on with isolated CABG between 2012-2014 were investigated retrospectively. The RIFLE (Risk, injury, failure, loss of function, and end-stage renal disease) risk scores were calculated for each patient in the third postoperative day. Patients were distributed into two groups in relation to the presence of acute kidney injury or not and these two groups were compared.Results: The urinary output (mL/kg/hour) during cardiopulmonary bypass in the acute kidney injury negative group was significantly higher than in the acute kidney injury positive group (P = .022). In case of a urinary output value 3.70 and lower to predict acute kidney injury positivity, sensitivity was detected as 71.43%. Results of the analysis for urinary output predict positivity of acute kidney injury.Conclusion: We suggest that urine output during cardiopulmonary bypass is a significant criteria that could predict acute kidney injury following coronary artery bypass grafting with cardiopulmonary bypass. Attempts to increase the urine output during cardiopulmonary bypass could help to maintain the renal functions during and after surgery.

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