Pulsatile Versus Nonpulsatile Flow During Cardiopulmonary Bypass: Extent of Hemolysis and Clinical Significance.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
Historique:
pubmed:
1
4
2020
medline:
2
3
2021
entrez:
1
4
2020
Statut:
ppublish
Résumé
Pulsatile flow has been used during cardiopulmonary bypass (CPB) for decades and its use is increasing with advancing extracorporeal technology. Pulsatile flow generates higher circuit pressures and shear forces than nonpulsatile flow at comparable pump flow and patient mean arterial pressure. Very little is known about the effect this has on erythrocytes. We included 62 adult patients (32 in the pulsatile group and 30 in the nonpulsatile group) undergoing elective coronary artery bypass grafting in this prospective observational study. Blood samples were collected at routine sampling times throughout surgery and were analyzed for the presence of free heme and globin using mass spectroscopy. Patient characteristics, CPB, and aortic cross-clamp times, pump flow as well as patient mean arterial pressure were similar in both groups. Maximum circuit pressure in the pulsatile flow group was statistically significantly higher than that in the nonpulsatile flow group (257.12 vs. 190.64 mmHg, p < 0.0001). Both heme and globin levels were higher in the pulsatile flow group. This reached statistical significance with globin at 30 minutes of CPB and with heme after aortic unclamping. We conclude that pulsatile CPB using roller pumps results in a greater extent of hemolysis. The clinical significance, however, is not yet known.
Identifiants
pubmed: 32224786
doi: 10.1097/MAT.0000000000001154
pii: 00002480-202009000-00009
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1025-1030Références
Wright G. Haemolysis during cardiopulmonary bypass: Update. Perfusion 2001.16: 345–351.
Rajbhandhari N, Rahman Z, Islam N, et al. Cardiopulmonary bypass induced hematological changes in patients undergoing cardiac surgery. Bangladesh Hear J 2015.30:53–57.
Vercaemst L. Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass : A review in search of a treatment algorithm. J Extracorpor Technol2008.40: 257–267.
Van Bijnen AA, Ganushchak YM, Heijmans JH, et al. Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage. Front Physiol 2014.5:1–9.
Omar HR, Mirsaeidi M, Socias S, et al. Plasma free hemoglobin is an independent predictor of mortality among patients on extracorporeal membrane oxygenation support. PLoS One 2015.10: e0124034.
Meyer A, Wiles A, Rivera O, et al. Hemolytic and thrombocytopathic characteristics of extracorporeal membrane oxygenation systems at simulated flow rate for neonates. Pediatr Crit Care Med. 2012.13: e255–e261.
Lodge AJ, Turi JL. Cardiopulmonary bypass is associated with hemolysis and acute kidney injury in neonates, infants and children. Pediatr Crit Care Med 201515:1–18.
Alghamdi AA, Latter DA. Cardiopulmonary bypass flow : An evidence-based approach. J Card Surg 2005.21: 347–354.
Haines N, Wang S, Undar A, Alkan T, Akcevin A. Clinical outcomes of pulsatile and non-pulsatile mode of perfusion. J Extra Corpor Technol 2009.41: P26–P29.
Koning NJ, Vonk AB, van Barneveld LJ, et al. Pulsatile flow during cardiopulmonary bypass preserves postoperative microcirculatory perfusion irrespective of systemic hemodynamics. J Appl Physiol (1985) 2012.112: 1727–1734.
Jameel S, Colah S, Klein A. Recent advances in cardiopulmonary bypass techniques. Contin Educ Anaesthesia, Crit Care Pain 2010.10: 20–23.
Burton RF. Estimating body surface area from mass and height: Theory and the formula of du bois and du bois. Ann Hum Biol 2008.35: 170–184.
Wilkens H, Regelson W, Hoffmeister FS. The physiolgic importance of pulsatile blood flow. N Engl J Med 1962.267: 443–446.
Gourlay T, Taylor KM. Pulsatile Cardiopulmonary Bypass. in Cardiopulmonary Bypass: Principles and Practice, Philadelphia, PA, Lippincott Williams & Wilkins, 2000.2nd ed.
Sarkar M, Vishal P. Basics of cardiopulmonary bypass. Indian J Anaesth 2017.61: 760–767.
Gu YJ, van Oeveren W, Mungroop HE, et al. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery. Artif Organs 2011.35: E18–E26.
Mulholland JW, Shelton JC, Luo XY. Blood flow and damage by the roller pumps during cardiopulmonary bypass. J Fluids Struct 2005.20: 129–140.
Simons AP, Wortel P, van Kan RA, van der Veen FH, Weerwind PW, Maessen JG. Pulse conductance and flow-induced hemolysis during pulsatile cardiopulmonary bypass. Artif Organs 2010.34: 289–294.
FF B. Studies on the hemolytic properties of protamine. J Gen Physiol 1961.44: 433–442.
Thomas C, Chb MB, Lumb AB, et al. Physiology of haemoglobin. Contin Educ Anaesthesia, Crit Care Pain 2012.12: 251–256.
Michael M, Jaeger U. Autoimmune Hemolytic Anaemia, Hematology. Elsevier, Amsterdam, The Netherlands, 2018, pp. 648–662.
Delanghe JR, Langlois MR. Hemopexin: A review of biological aspects and the role in laboratory medicine. Clin Chim Acta 2001.312: 13–23.
Rapido F. The potential adverse effects of haemolysis. Blood Transfus 2017.15: 218–221.
Domenico A, Dodonov M, Van Oeveren W, et al. Pulsatile cardiopulmonary bypass and renal function in elderly patients undergoing aortic valve surgery †. Eur J Cardio-Thoracic Surg 2015.47: 291–298.
Poswal P, Mehta Y, Juneja R. Comparative Study of pulsatile and nonpulsatile flow. Ann Card Anaesth 2004.7: 44–50.
Serraino GF, Marsico R, Musolino G, et al. Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial activation. Circ J 2012.76: 1121–1129.
Farid S, Povey H, Anderson S, Nashef SA, Abu-Omar Y. The effect of pulsatile cardiopulmonary bypass on the need for haemofiltration in patients with renal dysfunction undergoing cardiac surgery. Perfusion 2016.31: 477–481.
Baraki H, Gohrbandt B, Del Bagno B, et al. Does pulsatile perfusion improve outcome after cardiac surgery? a propensity-matched analysis of 1959 patients. Perfusion 2012.27: 166–174.
Coulson TG, McPhilimey E, Falter F, Abu-Omar Y, Klein AA. The Association between pulsatile cardiopulmonary bypass and acute kidney injury after cardiac surgery: A Before-and-After Study. J Cardiothorac Vasc Anesth 2020.34: 108–113.
Neil MPO, Fleming JC, Badhwar A, et al. Cardiopulmonary bypass : Microcirculatory and systemic effects. ATS 2012.94: 2046–2053.
Murkin JM. Monitoring and optimization of the microcirculation during CPB. J Thorac Dis 2019.11(suppl 10): S1489–S1491.