Gaseous Microemboli and the Influence of Microporous Membrane Oxygenators

Weitkemper, Heinz-Hermann; Oppermann, Bernd; Spilker, Andreas; Knobl, Hermann-J.; Körfer, Reiner

doi:10.1051/ject/200537256

Cited by 14 publications

(3 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The purpose of this study was to rank air-handling ability of several ECCs; however, the results of this study beg the question whether these measured differences are clinically significant. While the possibility of measuring GME volume in patients undergoing CPB is feasible (21), to date the GME load required to produce neurologic impairment in humans is difficult to establish (27). Several observational studies and one randomized control trial have successfully correlated negative neurological out- 21) that more research should be done to improve ECC components and clinical practice to eliminate GME.…”

Section: Clinical Relevancementioning

confidence: 99%

See 1 more Smart Citation

In Vitro Evaluation of the Air Separation Ability of Four Cardiovascular Manufacturer Extracorporeal Circuit Designs

Dickinson

Riley²,

Crowley³

et al. 2006

J Extra Corpor Technol

View full text Add to dashboard Cite

Neurologic impairment is a common complication of adult cardiac surgery. Cerebral gaseous microemboli (GME) detected during cardiopulmonary bypass has been associated with cognitive impairment after adult cardiac surgery. Several previous studies have shown that components comprising the extra-corporeal circuit (ECC) can affect the ability of the ECC to eliminate air. The differences in the air separation ability of four manufacturer’s commonly used ECCs were studied. The air-separating ability of Cobe Cardiovascular, Gish Biomedical, Medtronic, and Terumo Cardiovascular Systems Corp. ECCs were studied in vitro under clinically relevant conditions. Bolus and continuous venous air were introduced and output GME patterns by size, time, and count were measured (using an embolus detection device) and statistically analyzed. Graphic representations depicting elapsed time, GME size, and bubble count helped to visually rank the air-handling performance of the ECCs. There are significant air-handling differences between the ECCs tested. Overall, the blinded results reveal that ECC A and ECC C removed significantly (p < 0.001) more suspended GME than ECC B and ECC D. In the 50-mL venous room-air bolus and the 100 mL/min pulsed air challenges, ECC B and ECC D allowed significantly more GME to pass (p < 0.001) compared with ECC A and ECC C. For example, in a 2-hour pump run ECC C would deliver 480 potential high-intensity transient signals (HITS) compared with the 9600 from the ECC B during venous room air entrainment at 100 mL/min. There are substantial and significant air-handling differences between the ECCs from the four different manufacturers. The results from this work allow for objective characterization of ECCs air-separating ability. This additional information provides an opportunity for clinicians to potentially minimize the risks of arterial air embolization and its associated deleterious neurologic effects, while allowing clinicians to make better-informed consumer decisions.

show abstract

Section: Clinical Relevancementioning

confidence: 99%

“…Thus, the components comprising the ECC can affect the ability of the ECC to eliminate GME. Previous studies have evaluated the ability of CPB components to handle or remove entrained venous air (17)(18)(19)(20)(21). Results from this work have shown wide variations in GME removal rates between the ECC tested.…”

mentioning

confidence: 93%

In Vitro Evaluation of the Air Separation Ability of Four Cardiovascular Manufacturer Extracorporeal Circuit Designs

Dickinson

Riley²,

Crowley³

et al. 2006

J Extra Corpor Technol

View full text Add to dashboard Cite

show abstract

“…They also note that both oxygenators become less efficient in removing a given volume of air as blood flow is increased. This makes sense because the fiber bundle of the oxygenator can be considered a depth filter where the filter material actively removes, over time, adhering GME by diffusion through the microporous hollow fiber (4)(5)(6). The efficiency of a depth filter to remove particles or GME depends on the flow velocity inside the filter medium.…”

mentioning

confidence: 99%