Complement consumption during cardiopulmonary bypass: comparison of Duraflo II heparin-coated and uncoated circuits in fully heparinized patients

Perfusion ◽  
1996 ◽  
Vol 11 (4) ◽  
pp. 333-337 ◽  
Author(s):  
Ahmet Hamulu ◽  
Berent Discigil ◽  
Mustafa Özbaran ◽  
Tanzer Çalkavur ◽  
Erkan Kara ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Postoperative Period ◽  
Extracorporeal Circulation ◽  
Myocardial Revascularization ◽  
Control Group ◽  
Clotting Time ◽  
Normal Range ◽  
Activated Clotting Time ◽  
Systemic Heparinization

Heparin attachment to synthetic surfaces is one means of improving the biocompatibility of clinically used cardiopulmonary bypass (CPB) circuits. To assess the effect of heparin-coated circuits on complement consumption during CPB, 40 patients undergoing elective myocardial revascularization were prospectively randomized either to a group in which a completely Duraflo II heparin-coated circuit was used for perfusion (heparin-coated Group, n = 20 patients) or to a control group (n = 20 patients) in which an uncoated, but otherwise standard circuit was used. Full systemic heparinization was induced (activated clotting time, 480 seconds) in all the patients included in the study, regardless of which perfusion circuit was used. The two groups did not differ significantly in terms of bodyweight, aortic crossclamp and extracorporeal circulation times. No patient had difficulty in weaning from bypass and the postoperative period was uneventful in all patients. Concentrations of C3 and C4 were found to be within the 'normal' range in the prebypass period in both groups. There were no significant intergroup differences with regard to C3 and C4 consumption during CPB. We conclude that Duraflo II heparin- coated circuits have no effect in reducing complement consumption during CPB in fully heparinized patients.

Clinical application of heparin-coated perfusion equipment with special emphasis on patients refusing homologous transfusions

Perfusion ◽  
1991 ◽  
Vol 6 (3) ◽  
pp. 227-233 ◽  
Author(s):  
LK von Segesser ◽  
BM Weiss ◽  
E. Garcia ◽  
MI Turina
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Clinical Application ◽  
Final Outcome ◽  
Blood Products ◽  
Clotting Time ◽  
Homologous Blood ◽  
Coronary Artery Revascularization ◽  
Activated Clotting Time ◽  
Systemic Heparinization

Clinical application of heparin-coated cardiopulmonary bypass equipment during perfusion with low systemic heparinization is reported with special emphasis on patients refusing any transfusion of homologous blood or blood products. Using the described technique, coronary artery revascularization was successfully performed in three Jehovah's witnesses. During perfusion, the activated clotting time (ACT) was maintained above 180 seconds. Prebypass haematocrit was 38±3% and dropped to 22±2% during cardiopulmonary bypass in complete haemodilution. However, the haematocrit was 28±1 % at 24 hours after cardiopulmonary bypass and 32±1 % after seven days. Hence, cardiopulmonary bypass with low systemic heparinization may further reduce bypass induced morbidity and improve the final outcome in selected patients.

The activated clotting time loading dose response ratio (ACTLORR) as an indicator of heparin demand during cardiopulmonary bypass

Perfusion ◽  
1996 ◽  
Vol 11 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Ian J Reece ◽  
Gerrard Linley ◽  
Habib Al Tareif ◽  
Rollie DeVroege ◽  
Jitesh Tolia ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Dose Response ◽  
Loading Dose ◽  
Response Ratio ◽  
Clotting Time ◽  
Activated Clotting Time

Extracorporeal Lung Assist with Heparin-Coated Systems

1992 ◽  
Vol 15 (1) ◽  
pp. 29-34 ◽  
Author(s):  
R. Rossaint ◽  
K. Slama ◽  
K. Lewandowski ◽  
R. Streich ◽  
P. Henin ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Safety Margin ◽  
Bleeding Complications ◽  
Major Surgery ◽  
Clotting Time ◽  
Normal Range ◽  
Extracorporeal Lung Assist ◽  
Activated Clotting Time ◽  
Extracorporeal Gas Exchange ◽  
Extracorporeal Support

Extracorporeal lung assist (ELA) has been recommended for the treatment of ARDS if conventional therapy fails. However, the need for nearly complete anticoagulation is a major risk factor for hemorrhagic complications. We describe our experience with 13 ARDS patients treated with ELA using heparin-coated systems (Carmeda). Maintaining partial thromboplastin time and activated clotting time within or close to the normal range, even major surgery (20 thoracotomies and 2 laparotomies) could be performed without undue bleeding complications related to anticoagulation during extracorporeal support. Eight of the 13 patients survived. The use of heparin-coated systems allows prolonged ELA with nearly physiological coagulation function, permitting major surgical intervention. It enhances the safety margin of extracorporeal gas exchange and may ultimately extend its indications.

EVALUATION OF THE EFFECTIVENESS OF A CLOSED CIRCUIT IN COMPARISON WITH AN OPEN CIRCUIT OF CARDIOPULMONARY BYPASS

2021 ◽  
pp. 44-47
Author(s):  
Berik Tuishiev ◽  
Gulzhan Bayzhan ◽  
Sabina Samitova
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Postoperative Period ◽  
Open Circuit ◽  
Closed Circuit ◽  
Control Group ◽  
Study Group ◽  
Valve Insufficiency ◽  
Group 5 ◽  
Group 2

Objective is to evaluate the effectiveness of closed-loop surgeries with the planned duration of cardiopulmonary bypass more than 2 hours in the immediate postoperative period. Materials and methods. A study was carried out in the clinic over 10 patients (average age 47-56 years) with Diagnoses: Ascending aortic aneurysm, FC 3 aortic valve insufficiency, who underwent surgery for ascending aorta replacement, aortic valve replacement with coronary artery reimplantation. The patients were divided into 2 groups, the 1st group (5 patients) is the control group using an open cardiopulmonary bypass circuit, the 2nd group (5 patients) is the patients using a closed cardiopulmonary bypass circuit. The total time of cardiopulmonary bypass in both groups was 125-187 minutes. Results. In the 2nd study group, drainage blood loss significantly decreased, on average 60-100 ml compared to the control group, where the average drainage loss was 600-1500 ml. The need for blood transfusion was 5.1% in the 2nd group, compared with 43.4% in the control group. In the study group 2, the number of platelets in the postoperative period in patients was higher than in the control group. Conclusion. This study shows that a closed circuit, compared to an open one, allows complex heart surgeries with a planned duration of extracorporeal circulation of more than 2-3 hours.

Factors associated with errors in the heparin dose response test: recommendations to improve individualized heparin management in cardiopulmonary bypass

Perfusion ◽  
2020 ◽  
pp. 026765912095297
Author(s):  
Min-Ho Lee ◽  
William Riley
Keyword(s):  
Cardiopulmonary Bypass ◽  
Dose Response ◽  
Clotting Time ◽  
Critical Aspect ◽  
Heparin Dose ◽  
Factors Associated ◽  
Heparin Concentration ◽  
Activated Clotting Time

Background: A critical aspect of cardiopulmonary bypass (CPB) is to achieve full anticoagulation to prevent thrombosis and consumptive coagulation without using excessive amount of heparin. This can be achieved with heparin dose response (HDR) test in vitro to calculate an individualized heparin bolus to reach a target activated clotting time (ACT) and heparin concentration. However, we often observe that the measured ACT (mACT) with the calculated heparin bolus gives significant errors, both positive (mACT is higher than expected) and negative (mACT is lower), from expected ACT (eACT). Methods: We performed a retrospective study of 250 patients who underwent cardiac surgery to attain an error distribution of the mACT from eACT with calculated heparin bolus. In addition, it is aimed to identify possible patterns of baseline ACT (bACT), calculated heparin concentration (CHC) and HDR slope that are associated with the significant positive and negative errors. Results: We found that individualized heparin bolus by HDR test is consistently underestimated while it gave a significant number of positive and negative errors. Further analysis indicates that significant negative errors correlate with high bACT and slope and low CHC while significant positive errors with low bACT and slope and high CHC. Conclusion: The mACT can be substantially different from eACT. The accuracy of the HDR test appears to be dependent upon bACT, slope, and CHC. Based on our analysis, we provide several recommendations and a flow chart to improve the quality of individualized heparin management on CPB.

scholarly journals An Investigation of a New Activated Clotting Time “MAX-ACT” in Patients Undergoing Extracorporeal Circulation

2001 ◽  
Vol 92 (3) ◽  
pp. 578-583 ◽  
Author(s):  
Galina Leyvi ◽  
Linda Shore-Lesserson ◽  
Donna Harrington ◽  
Frances Vela-Cantos ◽  
Sabera Hossain
Keyword(s):  
Extracorporeal Circulation ◽  
Clotting Time ◽  
Activated Clotting Time

scholarly journals Anticoagulation in Cardiopulmonary Bypass

1977 ◽  
Author(s):  
C. Thomas Kisker ◽  
John A. Young ◽  
Donald B. Doty ◽  
Barbara J. Taylor
Keyword(s):  
Cardiopulmonary Bypass ◽  
Antithrombin Iii ◽  
Human Subjects ◽  
Mean Value ◽  
Clotting Time ◽  
Excessive Bleeding ◽  
Safe Level ◽  
Activated Clotting Time ◽  
Before And After ◽  
The Mean

Prolonging the activated clotting time (ACT) 2 to 3 times normal is said to provide a “safe” level of anticoagulation during cardiopulmonary bypass. To test this level of anticoagulation 9 monkeys were anticoagulated with heparin at the start of cardiopulmonary bypass so that ACT’s ranged from 201 sec to > 1000 sec (normal 91 sec). ACT, platelet count (P), fibrinogen (F), and fibrin monomer (FM) were measured at 10, 30, 60, 90, and 120 minutes during bypass. Antithrombin III (AT3) was measured before and after bypass. Six monkeys developed increased FM indicating active coagulation beginning from 10 to 60 minutes on bypass. ACT’s were > 200 sec in all animals at the time of FM detection. P fell below 100,000/mm3 in the 6 animals with elevated FM, but remained above 100,000/mm3 in the other 3 animals. The mean value of AT3 (69%) decreased to 24.4% after bypass in the 6 animals with elevated FM, but was 61% after bypass in the others. Scanning electron microscopy of the oxygenator membranes showed significant amounts of fibrin on the membranes used in monkeys who developed increased FM levels, but not on those with normal FM concentrations. F decreased from 167 mgm/dl to 80.5 mgm/dl in monkeys with elevated FM and to 117 mgm/dl in those with normal FM concentrations. Excessive bleeding did not occur in the animals without increased FM although ACT’s were in excess of 1000 sec. Subsequently three human subjects on cardiopulmonary bypass whose ACT’s were maintained above 400 sec have not shown increased FM levels. The results suggest that prolonging the ACT more than 2 - 3 times normal is required to prevent activation of clotting during cardiopulmonary bypass.

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