The effect of pulsatile flow on renal blood flow during extracorporeal circulation

Dalton, Martin L.; Mosley, Everett C.; Woodward, Kenneth E.; Barila, Timothy G.

doi:10.1016/s0022-4804(65)80007-5

Cited by 25 publications

(6 citation statements)

References 5 publications

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“…There was, however, greater postbypass pulmonary dysfunction in the pulsatile group in this experimental situa tion. This and more recent studies [11][12][13] indicate that, although pulsatile flow may favorably affect the distribution of blood flow to the microcirculation, a clear benefi cial effect of adding pulsation to flow during CPB has not been demonstrated.…”

Section: Alterations In Organ Perfusion and Metabolismmentioning

confidence: 95%

Cardiopulmonary Bypass: Studies on Its Damaging Effects

1987

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Despite the widespread safe application of cardiopulmonary bypass (CPB) for cardiac surgery, it is inherently a pathologic state. CPB produces a generalized inflammatory reaction involving at least the complement, coagulation, kallikrein, and fibrinolytic cascades.Marked alterations in organ perfusion and metabolism occur during CPB which are further affected by the perfusion flow rate. During hypothermic CPB at 20 °C, there is a progressive decrease in perfusion of the microcirculation at flow rates less than 1.2 liters/min/m2. Experimental studies suggest that brain oxygen consumption and resistance remain relatively constant as flow rates are reduced during hypothermia, and the brain becomes the passive recipient of proportionally more blood flow.Recent ultrafïltration studies have demonstrated a specific increase in microvascular permeability to proteins after 2 h of normo thermic CPB. This provides experimental support to the well-known clinical observation of increased interstitial fluid following CPB. The development of uniformly safe CPB depends upon prevention of the abnormalities of the micro-circulation and upon neutralization of the deleterious effects of inflammatory mediators.

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Section: Alterations In Organ Perfusion and Metabolismmentioning

confidence: 95%

Cardiopulmonary Bypass: Studies on Its Damaging Effects

1987

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“…However, there are some divergent studies, which detected similar or positive effects of pulsatile blood flow compared to continuous flow. In 1965, Dalton et al measured similar blood gases during an in vivo study with dogs . Furthermore, a similar cerebral blood flow , same serologic parameters , equal postoperative variables , and general inflammatory response during pulsatile and nonpulsatile blood flow were documented in patient studies.…”

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confidence: 91%

Effects of Pulsatile Blood Flow on Oxygenator Performance

et al. 2018

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Extracorporeal membrane oxygenation (ECMO) is mainly used for the therapy of acute respiratory distress syndrome and chronic obstructive lung disease. In the last years, the development of these systems underwent huge steps in optimization, but there are still problems with thrombus formation, clogging, and thus insufficient gas exchange. One idea of ECMO optimization is a pulsatile blood flow through the oxygenator, but this is still a controversy discussion. Analyzing available publications, it was not possible to identify a general statement about the effect of pulsatile blood flow on the gas exchange performance. The variety of parameters and circuit components have such a high influence on the outcome that a direct comparison of the studies is difficult. For this reason, we performed a structured study to evaluate the effects of pulsatile blood flow on the gas exchange performance of oxygenator. In in vitro tests according to DIN EN ISO 7199, we tested a small oxygenator (0.25 m exchange surface, polymethylpentene fibers, 33 mL priming volume) with constant and pulsatile blood flow in comparison. Therefore, we varied the mean blood flow from 250 to 1200 mL/min, the amplitude of 0, 20, and 50%, and the frequency of 30, 60, and 90 bpm. The results demonstrate that the gas transfer for pulsatile and constant blood flow was similar (oxygen: 36-64 mL /L ; carbon dioxide 35-80 mL /L ) for the same mean blood flow ranges. Over all, the results and analyses showed a statistically nonsignificant difference between pulsatile and nonpulsatile flow. Consequently, we conclude that the implementation of pulsatile blood flow has only a small to no effect on the gas exchange performance in an oxygenator. As the results were obtained using an oxygenator with a coiled fiber bundle, the test must be verified for a stacked fiber oxygenator.

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“…Non-pulsatile flow is associated with a depression of kidney function not found during pulsatile perfusion (Hooker, 1910;Gesell, 1913;Judson and Rausch, 1957;Many et al, 1967;Many et al, 1968aMany et al, , 1968bJacobs et al, 1969;Paquet, 1969); moderate to severe hydropic degeneration of kidney tubules is found only after non-pulsatile perfusion (Dalton, McCarty, Woodward, and Barila, 1965a;Dalton, Mosley, Woodward, and Barila, 1965b); and unilateral renal artery depulsation results in increases in juxtaglomerular cell granulation and in tissue renin content that correlate with decreases in sodium and water excretion .…”

Section: Pvr (Units)=ap (Mmhg)-vp (Mmhg)mentioning

confidence: 99%

Brain damage in dogs immediately following pulsatile and non-pulsatile blood flows in extracorporeal circulation

Sanderson

Wright

Sims

1972

Thorax

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T'he brains of dogs subjected to total cardiac bypass were examined for early signs of ischaemic nerve cell changes. Diffuse nerve cell changes were found immediately following two-and threehour non-pulsatile perfusions but not following pulsatile perfusions of the same durations. The nerve cell changes found in the brains were acute cell swelling and early isohaemic cell change. Acute cell swelling was found only in the cerebellar Purkinje cells. Ischaemic cell change was found in several regions of the brain but the cerebral cortex and cerebellar Purkinje cells were most frequently affected. Diffuse nerve cell changes are attributed to non-pulsatile blood flow but some complicating factors are recognized.Focal lesions found in three brains may have been due to embolism by blood cell aggregates and/or gas microbubbles.Roller pumps are currently in general use for the production of extracorporeal circulation during open-heart surgery. Their remarkable efficiency and easy control have been a hindrance to the development of alternative types of pump. However, an increasing volume of evidence supports the view that pumps producing pulsatile blood -flow would provide more efficient tissue perfusion than roller pumps producing ripple (non-pulsatile) blood flow. We have performed experiments to test this view using brain damage as a criterion for assessing tissue perfusion. MATERIALS AND METHODSGeneral anaesthesia was induced in 20 beagle and harrier dogs, 6-5-20-0 kg body weight, by intravenous injection of 0 25-0 5 g of sodium thiopentone (Intraval (DeBakey, 1934) or the MortonKeele prototype pulsatile pump (Sanderson et al.) with Harvard remote diaphragm heads. The circuit tubing was 6-0 mm internal 'diameter polyvinyl chloride (PVC). The reservoirs were also PVC and each reservoir had a capacity of 300 ml. The heat exchanger consisted of four stainless steel tubes each 15 m in length and with an internal diameter of 6-0 mm mounted in a copper water jacket. The heat exchanger was placed in the left atrial return instead of being in the delivery line from the left pump. This translocation was introduced to reduce damping of the pulse delivered by the pulsatile pump.All of the cannulae were made of stainless steel.The atria were drained through 6&0 mm internal diameter fenestrated cannulae. The internal diameters of the arterial cannulae were 4-0 or 5-0 mm for the pulmonary artery, 2 5, 3 0 or 3-5 mm for the femoral artery, and 4 0, 5 0 or 6-0 mm for the proximal aorta, depending upon the diameter of the lumen of the artery.The extracorporeal circuit was primed with 1,300 ml dog blood; 10 ml 10% low molecular weight dextran in 0-9% sodium chloride (Rheomacrodex) and 4 ml 10% mannitol/kg of body weight; plus 4 ml 20% sodium bicarbonate, 2,500 international units heparin, and 3 ml 20% calcium chloride/ 500 ml priming fluid.Using clean surgical techniques, a median sternotomy was performed to permit cannulation of the right and left atria and the pulmonary artery. For non-pulsatile flow, the aorta was retrogradely per...

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The effect of pulsatile flow on renal blood flow during extracorporeal circulation

Cited by 25 publications

References 5 publications

Cardiopulmonary Bypass: Studies on Its Damaging Effects

Cardiopulmonary Bypass: Studies on Its Damaging Effects

Effects of Pulsatile Blood Flow on Oxygenator Performance

Brain damage in dogs immediately following pulsatile and non-pulsatile blood flows in extracorporeal circulation

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