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CPB Circuit (cpb + circuit)
Selected AbstractsThe effect of bloodless pump prime on cerebral oxygenation in paediatric patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2004S. H. Han Background:, In paediatric patients, crystalloid prime for cardiopulmonary bypass (CPB) causes further haemodilution in comparison with blood-containing prime. Thus it may affect the cerebral oxygen supply/demand balance. The purpose of the study was to compare the effect of bloodless pump prime with that of blood-containing prime on cerebral oxygenation in children. Methods:, Thirty-six paediatric patients scheduled for elective repair of atrial or ventricular septal defect were enrolled. In Group C (n = 18), the CPB circuit was primed only with crystalloid. In Group B (n = 18), red blood cells were added to achieve a haematocrit (Hct) of 20% during CPB. The regional cerebral oxygen saturation (rSO2) value measured by near-infrared spectroscopy was compared between the two groups. Results:, In both groups, rSO2 decreased below baseline at the start of CPB and during rewarming (P < 0.001, for both groups during each period). At the start of CPB, haemodilution was greater in Group C than in Group B (Hct 16.1 ± 0.7% vs. 20.7 ± 0.5%; P < 0.01), and there was a greater reduction in rSO2 in Group C (49.0 ± 5.4% vs. 59.2 ± 7.0%; P < 0.01). During rewarming, rSO2 was significantly lower in Group C than in Group B (57.8 ± 5.3% vs. 62.8 ± 6.2%; P < 0.01). Conclusions:, In paediatric patients, the haemodilution associated with crystalloid priming causes a greater reduction in rSO2 than with blood-containing prime at the starting period of CPB and the rewarming period. [source] The Use of Bivalirudin for Cardiopulmonary Bypass Anticoagulation in Pediatric Heparin-Induced Thrombocytopenia PatientsARTIFICIAL ORGANS, Issue 8 2010Richard Gates Abstract Infants with heparin-induced thrombocytopenia (HIT) represent a challenging and high-risk group of patients when they require cardiopulmonary bypass (CPB). Bivalirudin offers many potential pharmacologic advantages over other nonheparin anticoagulants for such patients. We describe our protocol for the use of bivalirudin in a 5-month-old infant undergoing stage 2 Norwood for hypoplastic left heart syndrome. The patient was a 5- month-old, 6-kg infant who developed HIT after a bowel resection complicating initial Norwood stage 1. After sternotomy and dissection had been redone, the child received an initial dose of bivalirudin of 1.0 mg/kg and 0.5 mg/kg 5 min later. The CPB circuit was primed with 50 mg/kg bivalirudn/400 cc volume. With the initiation of CPB, a continuous infusion of 2.5 mg/kg bivalirudin was begun. Activated clotting time (ACT) was targeted for over 400 s, with an examination prior to bypass and each 15 min thereafter. Bivalirudin was discontinued with separation from bypass and during modified ultrafiltration (MUF). The ACT was 286 s after the initial 1 mg/kg bolus and 597 s after the second 0.5 mg/kg bolus and initiation of CPB. At a rate of 2.5 mg/kg/min, ACT ranged between 461 and 597 s. At the completion of MUF, the ACT was 316 s. The ACT was 214 s 20 min after MUF. No clots were noted in the CPB circuit, and good hemostasis was achieved within 10 min after MUF was completed. Incision to closure time was 160 min; time from completion of MUF to sternal closure was 30 min. Post-MUF, 60 cc of processed cell saver blood was reinfused, and no clotting factors were required. Chest tube output was 10, 10, 3, and 4 ccs, respectively, at hours 1,4 post operation. Bivalirudin provides effective anticoagulation in infants requiring CPB in the presence of HIT. Bivalirudin's efficacy is effectively monitored by ACT, and, after CPB, its short half-life and ability to be ultrafiltered facilitate the ability to achieve hemostasis in a timely fashion. [source] Clinical Real-Time Monitoring of Gaseous Microemboli in Pediatric Cardiopulmonary BypassARTIFICIAL ORGANS, Issue 11 2009Shigang Wang Abstract We describe the occurrence and distribution of gaseous microemboli with real-time monitoring in a pediatric cardiopulmonary bypass (CPB) circuit and in the cerebral circulation of patients using the Emboli Detection and Classification (EDAC) system and transcranial Doppler (TCD). Four patients (weights 3.2,13.8 kg) were studied. EDAC monitors were located on the venous line and on the postfilter arterial line to measure gaseous microemboli in the CPB circuit. TCD was used to measure high-intensity transient signals (HITS) in the middle cerebral artery. Before the initiation of CPB, EDAC detected gaseous microemboli in two cases when giving volume through the arterial line. At the initiation of CPB, gross air appeared in the venous line and gaseous microemboli were detected in the arterial line in all patients. EDAC detected a total of 3192,14 699 gaseous microemboli in the arterial line during the whole CPB period, more than 99% of which were smaller than 40 microns. After cessation of CPB, EDAC detected gaseous microemboli in the arterial line in all cases. The TCD detected HITS in two cases (25 and 315), and detected no HITS in two cases. We observed that the venous line acted as a principal source of gaseous microemboli, particularly when using vacuum-assisted venous drainage, and that a significant number of these gaseous microemboli smaller than 40 microns were subsequently transferred to the patient. Using EDAC and TCD together could strengthen the monitoring of gaseous microemboli in the extracorporeal circuit and cerebral circulation. [source] Impact of Off-Pump Coronary Artery Bypass Surgery on Systemic Inflammation: Current Best Available EvidenceJOURNAL OF CARDIAC SURGERY, Issue 5 2007Shahzad G. Raja M.R.C.S. Important features of this inflammatory reaction include the activation of complement and leukocytes, the release of proinflammatory cytokines, alterations in the metabolism of nitric oxide, and an increase in the production of oxygen-free radicals, which in some cases may lead to oxidant stress injury. Several strategies including the use of steroids, use of aprotinin, heparin-coated CPB circuits, and hemofiltration have been reported to reduce the inflammatory reaction induced by CPB and its consequences. A more radical and effective way of counteracting the effects of the inflammatory reaction and oxidative stress may be the omission of CPB itself. The development and application of off-pump coronary artery bypass (OPCAB) technology has largely been driven by this theme of avoiding systemic inflammatory reaction to decrease the incidence and/or severity of adverse outcomes. This review article discusses the influence of cardiopulmonary bypass on systemic inflammation and attempts to evaluate the current best available evidence on the impact of OPCAB on systemic inflammation. [source] Biocompatibility of Heparin-Coated Cardiopulmonary Bypass Circuits in Coronary Patients With Left Ventricular Dysfunction Is Superior to PMEA-Coated CircuitsJOURNAL OF CARDIAC SURGERY, Issue 6 2006Veysel Kutay M.D. The aim of this study was to evaluate the clinical effectiveness and biocompatibility of heparin-coated and poly-2-methoxyethylacrylate (PMEA)-coated CPB circuits on coronary patients with left ventricular systolic dysfunction. Methods: Thirty-six patients who underwent elective coronary artery bypass grafting were divided into two equal groups: group H (n = 18), heparin-coated; group P (n = 18), PMEA coated. Clinical outcomes, hematologic variables, cardiac enzymes, malondialdehyde (MDA), and acute phase inflammatory response (including myeloperoxidase (MPO), catalase, hsCRP, and IL-8) were analyzed perioperatively. Results: Demographic, CPB, and clinical outcome data were similar for both groups. Plasma fibrinogen, total protein, albumin, and platelet count decreased, neutrophil count, MDA, IL-8, MPO, and catalase levels increased during CPB. During CPB, MPO and catalase values were significantly higher in group P (p = 0.02 and p = 0.01) and postoperative MDA concentration was lower in group H (p = 0.03). Platelet counts were better preserved in group H during and after CPB but neutrophil count and IL-8 level did not differ between the groups. Postoperative total protein, albumin, and fibrinogen levels were higher in group H (p < 0.05). The postoperative first day levels of troponin-I, CK-MB, and CRP increased in both groups without any significant differences between the groups. Conclusions: Heparin-coated circuit provided better suppression of perioperative inflammatory markers and exhibited more favorable effects on hematologic variables than PMEA-coated circuit. [source] | ||||||||||