Reduced Intraoperative Blood Loss and Hypothermia in Burn Surgery using Cardiopulmonary Bypass Pumps

Objective: Patients presenting with total body surface area (TBSA) >40% burns require significant surgical treatment. Two substantial challenges during these surgeries are limiting blood loss and maintaining core temperatures. To overcome these challenges, several techniques have been developed, ranging from the Pitkin syringe method to the pneumatic tourniquet strategy for large-volume hyperthermic insufflation. Here, we compare the pneumatic tourniquet method to a roller pump method for maintenance of intraoperative normothermia and control of bleeding. Methods: We conducted a retrospective chart review of 20 patients presenting with TBSA >40% burns, 10 of whom were treated with the rapid infusion roller pump and 10 of whom were treated with the pneumatic tourniquet technique. Patients from each group were controlled for % TBSA, presence of inhalation injury, age, and date of admission. We reviewed transfusion requirement and the intraoperative temperatures, as well as the average intraoperative drop in temperature. Results: We observed improvement in the infusion volume, operative time, intraoperative temperature drop, minimum intraoperative temperature, estimated blood loss, and amount of required transfusion. Conclusions: Our study suggests that the rapid infusion roller pump technique is capable of achieving superior intraoperative bleeding control and temperature maintenance compared to the pneumatic tourniquet technique, resulting in decreased transfusion requirement.

AngioVac Suction Embolectomy Using a Roller Pump: Operative Technique

AngioVac suction embolectomy is recommended by the manufacturer to be performed with a centrifugal pump due to safety considerations. However, roller head pumps are significantly cheaper to use, and thus may be more readily available during shortages and in resource poor settings. We present the technique of Angiovac suction embolectomy being successfully performed with a roller pump to evacuate a clot-in-transit in the inferior vena cava and right atrium, along with discussion of important safety caveats.

Using a roller pump for establishing extra-corporal membrane oxygenation (ECMO) – technical considerations for times of crisis

Objective: The COVID-19 pandemic requires thinking about alternatives to establish ECMO when often-limited hardware resources are exhausted. Heart-lung-machines may potentially be used for ECMO but contain roller pumps as compared to centrifugal pumps in ECMO-circuits. We here tested roller pumps as rescue pump for ECMO-establishment. Methods: We set up in vitro circuits on roller pumps from C5 heart-lung-machine with 5 l/minutes flow. In two series, we placed either PVC or silicon tubing for an ECMO circuit into the roller pump. We assessed the mechanical stress on the tubing (aiming to run the pump for at least 1 week), measured the temperature increase generated by the friction and assessed flow characteristics and its measurement in simulated situations resembling tube kinking and suction. Results: The roller pumps led to expected and unexpected adverse events. PVC tubing burst between 36 and 78 hours, while silicon tubing lasted for at least 7 days. At 7 days, the silicone tubing showed significant signs of roller pump wear visible on the outside. The inside, however, was free of surface irregularities. Using these tubings in a roller pump led to a remarkable increase in circuit temperature (PVC: +12.0°C, silicone +2.9°C). Kinking or suction on the device caused the expected dramatic flow reduction (as assessed by direct measurement) while the roller pump display continued to show the preset flow. The roller pump is therefore not able to reliably determine the true flow rate. Conclusion: Roller pumps with silicone tubing but not PVC tubing may be used for running ECMO circuits. Silicone tubing may endure the roller pump shear forces for up to 1 week. Thus, repeated tubing repositioning may be a solution. Circuit heating and substantial limitations in flow detection should increase attention if clinical use in situations of crisis is considered.

Development of a valve type semi-closed extracorporeal circulation system

In Japan, perfusionists who work on other clinical tasks are involved in cardiopulmonary bypass. Moreover, the number of cases they can perform is limited. In view of this situation, valve type semi-closed extracorporeal circulation (VACC) was developed as a system that enables extracorporeal circulation (ECC) regardless of perfusionists’ experience. The VACC circuit is based on a conventional open-type ECC circuit. A safety valve is installed at the outlet of the reservoir. It is closed by lowering the reservoir pressure below the venous circuit pressure (Pv), thereby providing a closed-type ECC in which the reservoir is separated from the venous circuit (V-circuit). A closed-type ECC needs means to cope with negative pressure generated in the V-circuit and to remove air mixed in the V-circuit. Water experiments to verify the safety of the VACC were conducted. In experiments simulating low venous return, when the Pv dropped, the safety valve opened so that the V-circuit was connected to the reservoir, and the excessive negative pressure was relieved. In the VACC circuit, a bubble trap is installed in the V-circuit, and the air is degassed to the reservoir by a roller pump (D-pump). A water experiment was conducted to verify the principle of the constant degassing method using the D-pump. It verified that the blood storage volume could be maintained constant even if the D-pump is continuously driven. The VACC system provides handling of air mixed in the V-circuit and safety in the case of low venous return.

Peristaltic Roller Pump: Parametric Optimization for Hemolysis Control

This work aims to analyze the various types of peristaltic pumps by studying, in particular, the use of the peristaltic roller pump to highlight its critical issues and propose new effective and innovative solutions. One possible application of this device is in hemodialysis, which is a physical therapy substitution of kidney function that allows, in almost all cases, recovery and maintenance of the main biological functions while remaining the uremic condition. As for the extracorporeal one, the equipment used to purify the blood from toxic substances that are no longer normally eliminated by kidney filtration is divided mainly into two types: rotary peristaltic pump and a linear peristaltic pump. Having to work with a very particular fluid such as blood and in direct contact with the patient, they need to be extremely accurate and must ensure a constant and continuous functioning. The rotary peristaltic pump is the most widely used for hemodialysis and having been extensively studied in literature it has since found extensive solutions in the application field. As is well known, peristaltic pump refers to a device that exploits the principle of peristalsis to function, i.e. the transit of a bottleneck on a tube, in this case, the catheter, to push the fluid contained outwards. In particular, a roundabout peristaltic pump consists of a rotating structure consisting of two or more rollers that in turn revolve around their axis. With their displacement, the rollers clog adjacent catheter sections at a time so that after the first roller has passed the tube returns to its initial size creating the vacuum and then sucking the fluid. In this way, the liquid is pushed from the tube towards the patient. The motion of all these components is powered by an electric motor connected directly to the main rotating structure. The pumping of fluids through hoses using the propagation of a peristaltic wave has been the subject of design and scientific studies for more than 4 decades. This is easily justifiable since the phenomenon of peristalsis is known to be an important responsible mechanism of fluid transport in many biological organs. The goal is (starting on studies on the blood, a variable density fluid) to analyze in detail the peristaltic roller pump and propose its parametric optimization, aimed at determining the critical speed, beyond which the machine damages any kind of fluid that needs special treatment (blood, food, special gel, medical ointments and so on).