Circulating particles during cardiac surgery

Abstract

Shed blood is known to be a source of lipid micro-emboli in cardiac surgery. The aim of this study was to characterize the occurrence of these particles at different stages of the operation, and to study their occurrence in the circulation at multiple time-points after the retransfusion of shed blood. Forty-four patients undergoing routine surgery with cardiopulmonary bypass were included. Blood was sampled from the surgical field at different sampling locations during the operation. Shed blood was collected in a transfusion bag and retransfused. After which, blood was sampled from the arterial line of the heart-lung machine. A Coulter counter was used for particle determinion. The mean volume of shed blood collected was 340+/-215 ml. Particles in the size range 10-60 microm were found at varying concentrations, with the highest concentrations being found in blood collected after cannulation and from the pleura. After retransfusion of this blood, a biphasic response was seen in the blood drawn from the efferent line of the heart-lung machine. Particles are found in shed blood at all times during cardiac surgery, and when this blood was retransfused an increase was seen in particle concentration in the heart-lung machine.

A new approach for fat removal in a discontinuous autotransfusion device–concept and evaluation

“…Membrane lipids derived from cellular debris are known to be procoagulant and can also cause immunological reactions . Contamination of wound blood with fat particles frequently occurs in cardiac or orthopaedic surgery, where fat layers and circulating particles have been observed in wound blood . These particles are linked to cerebral dysfunction caused by ‘small capillary and arteriolar dilations’ (SCADs), which have been detected in human and animal brains after cardiopulmonary bypass surgery .…”

Comparison between transcranial Doppler and Coulter counter for detection of lipid micro embolization from mediastinal shed blood reinfusion during cardiac surgery

“…Furthermore, we chose to limit our correlation analyses to the aggregated number of particles detected by each method in the first 120 seconds after re-transfusion. This limit in time was based on our previous observations; this time period reflects emboli from the re-transfusion, and signals after 120 seconds reflect a recirculation of particles 4,5,15 . The finding was confirmed in the present investigation, as shown in Figure 1.…”

“…The methodology of the Coulter counter has previously been presented in detail 4,5 . In brief, a Multisizer 3 Beckman Coulter counter with a 100-µm aperture probe (Beckman Coulter Inc, Fullerton, CA) was used for particle size determination.…”

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

“…Embolization is associated with most infusion therapies although the sources of micro emboli during CPB is multiple, especially from the CS 52 . Debris from the circuit can be easily be removed with a 0.2 µm pre bypass filter 53 before the patient is connected to the circuit.…”