Pulsatile Versus Nonpulsatile Cardiopulmonary Bypass Flow: An Evidence-Based Approach

Abstract

The evidence is conflicting and therefore does not support making recommendation for or against routinely providing the PP to reduce the incidence of mortality or MI. The evidence is insufficient to recommend for or against routinely providing the pulsatile profusion to reduce the incidence of stroke or renal failure.

Cardiopulmonary bypass with physiological flow and pressure curves: pulse is unnecessary!☆

“…The use of pulsatile flow for cardiopulmonary bypass in human patients was most popular during the 1980s and the early 1990s; however, until now, most clinical studies have failed to demonstrate any benefit of the pulsatile flow mode [6].…”

“…In the 1980s these findings led to the temporary adoption of pulsatile flow in clinical routine by using modified roller pumps for ECC, which were able to generate some pulsatility by periodic acceleration and deceleration of the pump. However, most clinical studies performed subsequently did not detect a benefit associated with pulsatile perfusion [6]. Consequently, currently, the more simple nonpulsatile flow has been widely re-established as the standard perfusion mode in cardiac surgery.…”

An Assessment of Renal Function with Pulsatile Perfusion During Proximal Graft Using Cardiac Contraction in Coronary Artery Bypass Graft Surgery

“…The evidence is insufficient to recommend for or against routine pulsatile profusion for lessening the incidence of stroke or renal failure (8). …”

Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion

“…T he controversy of pulsatile vs nonpulsatile perfusion during cardiopulmonary bypass (CPB) remains unsolved [1,2]. Although a number of studies are unable to demonstrate any advantage of pulsed CPB perfusion [2][3][4], pulsatile CPB flow has been associated with improved cardiac, renal, and pulmonary outcomes, better cytokine profiles, endothelin and hormone levels, and an improved respiratory index [1].…”