A Comparative Study of Five Filtered Cardiotomy Reservoirs

Swanney, Peter J.

doi:10.1051/ject/19861817

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…This fact is interesting when we consider that up to 50% of detected cerebral emboli may not be directly associated with surgical manipulation and their actual sources are still considered to be uncertain (17)(18)(19). External cardiotomies are still an essential component of modern day soft shell and hard shell venous reservoirs during CPB, but they may also be a source of GMEs if not clamped out during CPB (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…They found that one way to dramatically reduce the amount of GMEs coming from cardiotomy reservoirs was by clamping the line and holding this blood for a period of time to allow the gaseous bubbles to settle out in the reservoir. The third paper in 1986 by Swanney (12) examined the ability of five cardiotomy Abstract: During a previously published study on gaseous microemboli (GMEs) and perfusionist interventions, it was noted that emboli could be detected after the arterial filter when blood/air challenges entered the membrane oxygenator's integral cardiotomy. The findings indicated that further study into the oxygenator's integral cardiotomy reservoir was warranted.…”

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confidence: 99%

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Post-Arterial Filter Gaseous Microemboli Activity of Five Integral Cardiotomy Reservoirs during Venting: An In Vitro Study

Myers¹,

Voorhees²,

Haynes³

et al. 2009

J Extra Corpor Technol

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During a previously published study on gaseous micro-emboli (GMEs) and perfusionist interventions, it was noted that emboli could be detected after the arterial filter when blood/air challenges entered the membrane oxygenator’s integral cardiotomy. The findings indicated that further study into the oxygenator’s integral cardiotomy reservoir was warranted. This is the first know published report that connects the vent return to GME activity after the arterial filter. To study the air handling ability of the membranes integral cardiotomy, an in vitro study was conducted on five hard shell coated membrane oxygenators (Terumo Capiox SX25, X coated; Sorin Synthesis, phosphorylcholine coated; Gish Vision, GBS coated; Medtronic Affinity NT, trillium coated; Maquet Quadrox, bioline coated). The oxygenators were matched with their own manufacturer’s coated arterial filters (Medtronic 351T Arterial Filter, Sorin Synthesis Integrated Arterial Filter, Terumo CXAF200X Arterial Filter, Gish GAF40GBS-2 Arterial Filter, and Maquet Quart HBF140 Arterial Filter). There were three arms to the study, and three separate oxygenator/filter combinations were used in each arm. The first arm consisted of a pump flow of 4.0 L/min with only the filter purge blood entering the integral cardiotomy. In the second arm, 500 mL/min of simulated vent blood was added to the filter purge blood entering the integral cardiotomy. During the final arm, 200 mL/min of air was added to the vent blood as it entered the integral cardiotomy, to more closely simulate vent return during cardiopulmonary bypass. All GME activity in the oxygenator/filter combinations was examined using the Hatteland CMD20 Microemboli Counter. Placement of the Hatteland probes was 4 in after the hard shell reservoir outlet (PRO) and 12 in after the arterial filter (PAF). When vent blood flow was turned on, there was a significant increase in the PRO microemboli activity detected in all reservoirs. In the PAF position, three of the oxygenator/filter combinations were able to remove 98–99% of the GME, one removed 84.3%, and another removed only 55.5% of the GMEs coming out of the oxygenator’s reservoir. All oxygenators were found to have a dramatic increase in reservoir GME activity when the vent was turned on. Depending on the oxygenator/filter combination, vent return into the oxygenator’s integral cardiotomy resulted in the presence of significant amounts of GMEs after the arterial filter.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Post-Arterial Filter Gaseous Microemboli Activity of Five Integral Cardiotomy Reservoirs during Venting: An In Vitro Study

Myers¹,

Voorhees²,

Haynes³

et al. 2009

J Extra Corpor Technol

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Filtration of shed mediastinal blood

et al. 1993

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Re-infusion of shed blood carries the risk of re-infusing cellular debris. All re-infusion devices have some sort of integral filtration which is variably supplemented with a second intravenous filter. Using electron microscopy we have observed what debris is collected by secondary filtration. In 12 patients studied, nine out of 12 filters had significant amounts of cellular debris present, but not clearly related to increased rates of postoperative bleeding. Noncellular debris, silicon and strands of cellulose were also observed. Although we have not detected any clinically significant embolic phenomena from re-infusion of shed mediastinal blood, it seems prudent to include a second filter prior to re-infusion.

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Prebypass filtration of cardiopulmonary bypass circuits: an outdated technique?

2003

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Filtration of cardiopulmonary bypass (CPB) priming fluid before connection of the circuit to the patient was first accomplished by arterial line filtration. When dedicated prebypass filters (PBFs) with smaller pore sizes became available, a large number of particles could be found on the filter surface. In recent years, modern manufacturing methods for CPB circuit components were believed to be associated with a reduced number of particles found in components of extracorporeal circuits, making separate filtration of CPB priming solution unnecessary. Microemboli generated during the preparation and priming procedure of the CPB circuit may consist of either solid particles or gaseous emboli and may contribute to patient morbidity. Endotoxins found in infusion solutions and CPB priming solutions may trigger inflammatory responses when administered into the circulatory system. Filtration of crystalloid CPB priming solutions with a PBF consisting of a filter membrane with a pore size of 0.2 microm was found to effectively reduce the number of microemboli. Infusion filters with a filter pore size of 0.2 microm were found to reduce the endotoxin contamination in infusion solutions. Prebypass filtration with filters containing pores of 0.2 pm should be a necessity for contemporary perfusion practice.

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A Comparative Study of Five Filtered Cardiotomy Reservoirs

Cited by 3 publications

References 3 publications

Post-Arterial Filter Gaseous Microemboli Activity of Five Integral Cardiotomy Reservoirs during Venting: An In Vitro Study

Post-Arterial Filter Gaseous Microemboli Activity of Five Integral Cardiotomy Reservoirs during Venting: An In Vitro Study

Filtration of shed mediastinal blood

Prebypass filtration of cardiopulmonary bypass circuits: an outdated technique?

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