A Novel Calculation of Priming Volume and Required Packed Cell Transfusion to Maintain Optimal Haematocrit During Cardiopulmonary Bypass

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.

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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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Practical techniques Vacuum-assisted venous return in pediatric cardiopulmonary bypass

Perfusion ◽

10.1177/026765910001500109 ◽

2000 ◽

Vol 15 (1) ◽

pp. 63-67 ◽

Cited By ~ 15

Author(s):

Richard Berryessa ◽

Robert Wiencek ◽

John Jacobson ◽

Dan Hollingshead ◽

Ken Farmer ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Adverse Effects ◽

Venous Return ◽

Maximum Flow ◽

Early Summer ◽

Pediatric Cardiac Surgery ◽

Priming Volume

Vacuum-assisted venous return (VAVR) has been reported to offer benefits for adults undergoing cardiopulmonary bypass (CPB), such as improved venous return, lowering priming volume (by eliminating the need to prime the venous line), and the use of smaller venous cannulae. All these benefits would be of particular value in pediatric perfusion because of the unique challenges of these smaller patients and the relatively large components of the CPB circuit. We have been using VAVR in children since the early summer of 1998 after we became comfortable with the technique and convinced of its efficacy in adults. Ours is a medium-sized pediatric caseload of slightly more than 100 CPB cases per year. With that caseload, it is most effective for us to minimize the inventory of different sizes of disposables used. We have opted for an oxygenator/reservoir that has a maximum flow of 4 liters with a priming volume of about 1 liter. We have been unhappy with the large prime volume in infants and earlier, in 1997-1998, were using a smaller prime oxygenator/reservoir until it was recalled. Faced again with a larger priming volume in the infants, we decided to try vacuum to decrease hemodilution and to evaluate other possible benefits. Through the use of VAVR, we have been able to decrease our priming volume, use smaller venous cannulae, and have more consistent return while experiencing no adverse effects of VAVR in our pediatric cardiac surgery patients.

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Effect of priming volume on serum catecholamines during cardiopulmonary bypass

Canadian Anaesthetists Society journal / Journal de la Société canadienne des anesthésistes ◽

10.1007/bf03007775 ◽

1980 ◽

Vol 27 (2) ◽

pp. 135-139 ◽

Cited By ~ 13

Author(s):

Kanteerava Balasaraswathi ◽

Silas N. Glisson ◽

Adel A. El-Etr ◽

Challapalli Azad

Keyword(s):

Cardiopulmonary Bypass ◽

Priming Volume

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In vitro and in vivo evaluation of Dideco’s paediatric cardiopulmonary circuit for neonates weighing less than five kilograms

Perfusion ◽

10.1177/0267659110375645 ◽

2010 ◽

Vol 25 (4) ◽

pp. 229-235 ◽

Cited By ~ 4

Author(s):

AS Thiara ◽

V. Eggereide ◽

T. Pedersen ◽

H. Lindberg ◽

AE Fiane

Keyword(s):

Cardiopulmonary Bypass ◽

Artificial Ventilation ◽

Postoperative Bleeding ◽

Gas Bubbles ◽

Venous Drainage ◽

In Vivo Evaluation ◽

Priming Volume ◽

Postoperative Haemoglobin

The neonate cardiopulmonary bypass (CPB) circuit, including a KIDS D100 oxygenator (The Sorin Group, Mirandola, Italy) and a D130 arterial filter (The Sorin Group), was evaluated in vitro with respect to the removal of free micro gas bubbles. No gas bubbles > 40µm were measured after the arterial filter D130 upon manual introduction of 10 ml of air into the venous line or during the use of vacuum-assisted venous drainage (VAVD). The D130 arterial filter removed 88 % of gas bubbles < 40 µm during manual introduction of air into the venous line; however, only 50 % of gas bubbles < 40 µm were removed during the use of VAVD. The same CPB circuit was evaluated in vivo to compare with another CPB circuit, including a D901 oxygenator (The Sorin Group) and arterial filter D736 (The Sorin Group), in 155 neonates weighing ≤5 kg. The D100 circuit required significantly less priming volume than the D901 circuit. Postoperative haemoglobin was significantly higher, artificial ventilation time was significantly shorter and postoperative bleeding was significantly less in the D100 group. This neonate CPB circuit effectively removed the gas bubbles and required up to 37% less priming volume and, thus, decreased the need for blood transfusion.

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The use of a mini bypass system (Cobe Synergy) without venous and cardiotomy reservoir in a mitral valve repair: a case report

Perfusion ◽

10.1191/0267659105pf794cr ◽

2005 ◽

Vol 20 (2) ◽

pp. 121-124 ◽

Cited By ~ 4

Author(s):

M AJM Huybregts ◽

R de Vroege ◽

H MT Christiaans ◽

A L Smith ◽

R CE Paulus

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Additional Degree ◽

Shed Blood ◽

Degree Of Protection ◽

Priming Volume ◽

Fusion Cell ◽

Automatic Removal

The use of mini cardiopulmonary bypass circuits is an emerging technology. The venous and cardiotomy reservoir have been excluded from the circuit. This results in a reduction of the blood contact surface area and of the priming volume. Entrainment of venous air, however, remains a drawback in the widespread acceptance of using these mini circuits. The technique described resolves this problem by automatic removal of venous air, and explains how this mini cardiopulmonary bypass circuit was utilized on a 64-year-old female presented for a mitral valve repair. In the absence of a cardiotomy reservoir, an autotrans-fusion cell separator was used to process shed blood and, after CPB, the residual pump blood. This mini bypass circuit, with the safety feature to remove automatically venous air, provided an additional degree of protection. In our experience, mini bypass circuits allow us safely to perform cardiopulmonary bypass during valve procedures.

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New technology increases perioperative haemoglobin levels for paediatric cardiopulmonary bypass: what is the benefit?

Perfusion ◽

10.1191/0267659106pf835oa ◽

2006 ◽

Vol 21 (1) ◽

pp. 39-44 ◽

Cited By ~ 2

Author(s):

Clarke Thuys ◽

Stephen Horton ◽

Martin Bennett ◽

Simon Augustin

Keyword(s):

Cardiopulmonary Bypass ◽

Haemoglobin Level ◽

New Technology ◽

Children's Hospital ◽

Priming Volume ◽

Children’S Hospital ◽

Membrane Oxygenators

Increasing perioperative haemoglobin level by reducing priming volume and maintaining a safe cardiopulmonary bypass (CPB) system is the aim of every perfusionist. In this study, we have compared the two membrane oxygenators and pump systems used for paediatric bypass at the Royal Children’s Hospital on a regular basis since 1988. We looked at all patients who had the Cobe VPCML (Cobe Laboratories, Denver, CO, USA) and Terumo RX-05 (Terumo Corporation, Tokyo, Japan) oxygenators used for flows from 800 mL/min up to the maximum rated flow for the respective oxygenator from January 2002 until March 2004. The VPCML refers to using only the 0.4-m2 section of the oxygenator. The pump systems used were the Stöckert CAPS (Stöckert Instrumente GmbH, Munich, Germany) and Jostra HL 30 (Jostra AB, Lund, Sweden). Changing from the VPCML to the RX-05 resulted in a 37% reduction in priming volume. The introduction of the Jostra HL 30 with a custom-designed mast system reduced the priming volume by another 15%. This change in priming volume allowed a significant increase, from 6 to 34%, in the percentage of patients who received bloodless primes, and for those patients who received blood primes, an increase in haemoglobin (Hb) on bypass from 8.2 to 9.6 g/dL, on average.

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Effects of cardiopulmonary bypass with low-priming volume on clinical outcomes in children undergoing congenital heart disease surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01151-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lei Wang ◽

Qiang Chen ◽

Yong Qiang Qiu ◽

Jian Xi Ye ◽

Jian Zhi Du ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Clinical Outcomes ◽

Congenital Heart ◽

Priming Volume

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Albumin priming improves the efficiency of the Minntech HPH Jr. hemoconcentrator

Perfusion ◽

10.1177/0267659118764270 ◽

2018 ◽

Vol 33 (7) ◽

pp. 520-524

Author(s):

Jeffrey L. Burnside ◽

Todd M. Ratliff ◽

Ann Salvator ◽

Ashley B. Hodge

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Study Groups ◽

Heparin Group ◽

Fluid Removal ◽

Priming Volume ◽

Priming Process ◽

Flow Through ◽

Group 2 ◽

Group 1

The desired use of the HPH Jr. is optimal due to the low priming volume; however, the lower rate of volume removal necessitates utilization of a larger hemofilter. Larger hemofilters carry a higher prime volume, which is impactful in the pediatric setting. Pediatric cardiac surgery patients under 18 kilograms requiring cardiopulmonary bypass were randomly assigned to one of two study groups. Group 1 (coated) contained an HPH Jr. hemofilter that was primed with the addition of 25% albumin and heparin. Group 2 (non-coated) contained an HPH Jr. hemofilter that was primed with only Normosol-R®. After cardioplegia delivery, zero balance ultrafiltration (ZBUF) was initiated and maintained for thirty consecutive minutes. The flow through the hemofilter was standardized at 70 ml/min and the vacuum applied to the effluent line was set at -150 mmHg. Effluent fluid removal was measured at the termination of thirty minutes and compared between the groups. Group comparisons between the coated vs non-coated hemofilter groups were assessed using two-sample t-tests or the Mann-Whitney U test, when appropriate. Forty-two patients were included in the analysis. There were 22 patients who had the non-coated hemofilter and 20 patients with a coated hemofilter. The differences between the two groups are illustrated in Table 1. There was a statistically significant higher ultrafiltration volume with the coated hemofilter group (p=0.008) (Figure 1). These results illustrate the improved efficiency of the HPH Jr. with the addition of 25% albumin and heparin during the priming process.

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Miniaturization in cardiopulmonary bypass

Perfusion ◽

10.1191/0267659103pf676oa ◽

2003 ◽

Vol 18 (4) ◽

pp. 219-224 ◽

Cited By ~ 31

Author(s):

Ludwig K von Segesser ◽

Piergiorgio Tozzi ◽

Iker Mallbiabrrena ◽

David Jegger ◽

Judith Horisberger ◽

...

Keyword(s):

Clinical Practice ◽

Cardiopulmonary Bypass ◽

Systematic Approach ◽

Red Cell ◽

Oncotic Pressure ◽

Suction System ◽

Key Technology ◽

Priming Volume ◽

Tremendous Progress ◽

Cardiac Operations

Cardiopulmonary bypass (CPB) remains the key technology for more complex cardiac operations. The perfusion equipment used nowadays has seen tremendous progress since its introduction into clinical practice 50 years ago. However, overall, CPB is still far from perfect. Major haemodilution is not only a problem for red cell-dependent gas transport, but also for the platelet and humeral factor-dependent coagulation, the protein-dependent intravascular oncotic pressure and so forth. Reduction of the priming volume through further miniaturization of CPB equipment is, therefore, the most obvious next step. A systematic approach needs to optimize all CPB components, including pumps, oxygenator/heat exchanger structures, filters, reservoirs, cardiotomy suction, tubings and cannulas. This report provides an update of already commercially available low prime perfusion devices (e.g., the CORx integrated pump-oxygenator) as well as promising prototypes like the smart suction system and the smartcanula.™

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