Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

Chatterjee, Subhasis

doi:10.4172/2155-9880.s7-001

Cited by 3 publications

(6 citation statements)

References 33 publications

(31 reference statements)

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“…8 The air-blood contact and stasis in the reservoir leads to clots and thrombin generation and further activation of the inflammatory cascade. 9 There are descriptions of use conventional CPB machine for prolonged post cardiotomy cardiac support, by converting this into a closed circuit. Typically, this has been done by incorporating a closed bladder and closing the line to cardiotomy reservoir.…”

Section: Discussionmentioning

confidence: 99%

“…8 The air-blood contact and stasis in the reservoir leads to clots and thrombin generation and further activation of the inflammatory cascade. 9…”

Section: Discussionmentioning

confidence: 99%

“…Typically, this has been done by incorporating a closed bladder and closing the line to cardiotomy reservoir. 9,10 The incorporation of closed bladder prevents the airblood interface, clot formation, activation of coagulation cascade, coagulopathy, and the deleterious effects of recurrent blood transfusion. Since there is no stasis of blood in a closed circuit, as described in the modification of CPB circuit, maintenance of ACT in a lower range is possible; thus, avoiding bleeding complication and reducing requirement of blood transfusion and better platelet preservation.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, this has been done by incorporating a closed bladder and closing the line to cardiotomy reservoir. 9,10…”

Section: Discussionmentioning

confidence: 99%

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Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function

Das¹,

Das

Dutta

et al. 2022

Perfusion

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Introduction Extracorporeal Membrane Oxygenation (ECMO) is used as a bridge to recovery of cardiac function following completion of congenital cardiac surgeries where there is failure to wean from cardiopulmonary bypass (CPB) or severe low cardiac output states in the post operative periods. Although ECMO is a well-established form of mechanical circulatory support, the associated cost can be a huge financial burden on families. We are an ECMO center and use the same in post operative congenital cardiac surgeries for mechanical cardiovascular support if needed. However, a significant proportion of the children, whom we operate, are funded by government aides. The resources are limited in such circumstances. If needed, we use the same CPB circuit and cannulae used in the Operating Room (OR) and support them at a significantly lower cost compared to ECMO. Methods We report our experience of using conventional CPB machine as a short-term bridge to recovery of cardiac function in Intensive Care Unit where there was limitation of funds. Essentially same CPB circuit with roller pump is retained, by omitting cardiotomy suckers. We use D901 Lilliput 1 Oxygenator (Sorin, Italy) for children <5 kg and D902 Lilliput 2 (Sorin, Italy) Oxygenator for children >5 Kg. Results We supported nine patients on CPB between March 2019 and December 2021. During this time, 1392 congenital cardiac surgeries were performed. We could wean off three patients (33.3%) and discharge two patients (22.2%). Our support time ranged from 21 h to 60 h with a median of 48 h. Beyond 48 h of support, we experienced several CPB induced complications in our cohort. Conclusion In resource-limited settings, conventional CPB machines can be used for short-term cardiac support. Although results may not be comparable to using ECMO, some patients can be definitely salvaged, who would otherwise die in the absence of institution of mechanical circulatory support.

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Section: Discussionmentioning

confidence: 99%

“…8 The air-blood contact and stasis in the reservoir leads to clots and thrombin generation and further activation of the inflammatory cascade. 9…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Typically, this has been done by incorporating a closed bladder and closing the line to cardiotomy reservoir. 9,10…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function

Das¹,

Das

Dutta

et al. 2022

Perfusion

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“…Several modifiable factors playing a role in the likelihood of a patient receiving blood transfusion have been identified, including the priming volume of the CPB circuit. 10 , 11 Measures used to avoid or minimize the use of transfusion products include preoperative iron and erythropoietin supplementation, 12 techniques to reduce the priming volume of the CPB circuit by means of a minimized system, 13 the use of cell salvage devices for autotransfusion, 14 , 15 and retrograde autologous priming (RAP). During the latter, a part of the patient’s own blood is passively drained into the CPB circuit, replacing part of the crystalloid or colloid-based priming solution before initiating bypass.…”

Section: Introductionmentioning

confidence: 99%

Retrograde autologous priming to reduce allogeneic blood transfusion requirements: a systematic review

et al. 2020

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Background: Efforts have been made to minimize transfusion of packed red blood cells in patients undergoing cardiac surgery with cardiopulmonary bypass. One method concerns retrograde autologous priming. Although the technique has been used for decades, results remain contradictory in terms of transfusion requirements. Objective: This systematic literature review aimed to summarize the evidence for the efficacy of retrograde autologous priming in terms of decreasing perioperative packed red blood cell requirements in adults. Methods: Two researchers independently searched PubMed for articles published in the past 10 years. The modified Cochrane collaboration Risk of Bias Tool and the Research Triangle Institute Item Bank were used to assess bias. Results: Eight studies were included, of which two randomized and six observational studies. Five studies, including one randomized study, report a significant decrease in packed red blood cell use in the retrograde autologous priming group compared to no retrograde autologous priming used. All studies are flawed by at least a high risk bias of bias score on one item of the bias assessment. Conclusion: Although most studies reported significantly fewer packed red blood cell transfusions in the retrograde autologous priming group, it is important to note that relatively few articles are available which are flawed by several types of bias. Prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of retrograde autologous priming.

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Trends in cardiac anaesthesia

Zeng

Hwang

2016

Trends in Anaesthesia and Critical Care

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Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

Cited by 3 publications

References 33 publications

Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function

Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function

Retrograde autologous priming to reduce allogeneic blood transfusion requirements: a systematic review

Trends in cardiac anaesthesia

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