gaseous micro-emboli removal during priming procedure using … oct 2016.pdf · gaseous...
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Gaseous Micro-Emboli Removal during priming procedure using pulsatile flow with 4 different adult oxygenators with integrated arterial filter and open reservoir. D. Hella1, M.G. Lagny1, T. Amand1, J.N. Koch1, J. Goffoy 1 , F. Blaffart1, J.O. Defraigne2. 1. ECCP, Department of Cardiovascular and Thoracic Surgery (Prof JO Defraigne), University Hospital of Liège, Liège, Belgium. 2. MD, PhD, Head of Department of Cardiovascular and Thoracic Surgery, University Hospital of Liège, Liège, Belgium.
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Dominique Hella, ECCP
The normal physiological way our heart pumps blood throughout our body is using Pulsatile Flow.
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Dominique Hella, ECCP
Tests in vitro: one of each type of oxygenator to know their limits with Pulsatile Flow Optimal setting for PF with S5 = 45/75/35 Recorded pressures: 4 negative peaks/10sec
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Dominique Hella, ECCP
Pulsatile Flow during CPB => High velocity => High amounts of energy => Some negative pressures => ECC circuit must be stressed before CPB during priming procedure => Protection against Fluid leakage Rupture of the membrane Abnormal appearance of air in the circuit
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Dominique Hella, ECCP
Priming protocole: 2 Liters of Plasmalyte A 37°C 200mmHg Dynamic occlusivity Continuous flow (CF) - 2 min (Gampt) Pulsatile flow (PF) - 2 min (Gampt)
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Dominique Hella, ECCP
Roller pumps Stöckert S5 - Liva Nova 10 Priming procedures/ oxygenator 4 modern adult oxygenators: Affinity Fusion®- Medtronic n = 10 Capiox FX25® - Terumo n = 10 Inspire 8F® - Liva Nova n = 10 Quadrox i®- Maquet n = 10
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Dominique Hella, ECCP
The Gampt BCC200:
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Dominique Hella, ECCP
Data recorded by the Gampt BCC200: QF NumRed % VolRed% Number Volume
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60
65
70
75
80
85
90
95
100
NumRed (%) CF NumRed
(%) PF VolRed (%) CF VolRed (%)
PF
77,9
90,2
71,7
88,8
94,8 96,1
92,3 84,5
100 100 100 100
100 99,6 100 100
GME reduction by oxygenator and flow mode
Quadrox i n=10 Inspire 8F n=10 Terumo FX25 n=10 Fusion Affinity n=10
Dominique Hella, ECCP
Comparison between oxygenators: p-value < 0,001 for all variables
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10
0 500
1000 1500 2000 2500
7,5 65,5
2080 2028
42 92 20,5 47
Unit
Number IN
0
0,2
0,4
0,6
0,8
0,03 0,13
0,23 0,18 0,05
0,72
0,02 0,08
µl
Volume IN
0
20
40
60
0 1
51,5 40
4,5 10
0 0
Unit
Number OUT
0
0,02
0,04
0,06
0
0,02 0,01
0,02
0,04 0,05
0 0
µl
Volume OUT
GME number and volume by oxygenator and flow mode
Dominique Hella, ECCP
Continuous Pulsatile Continuous Pulsatile
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0
0,01
0,02
0,03
0,04
0,05
Continuous flow Pulsatile flow
0
0,02
0,01
0,02
0,04
0,05
0 0
GME volume downstream oxygenator
µL
Dominique Hella, ECCP
Dominique Hella, ECCP
Conclusion: In vitro ≠ In vivo Venous reservoir: the more sensitive piece of the circuit? Gampt: built to be used with continuous flow => Prospective and randomized study: to show the airhandling of 5 oxygenators during CPB comparing continuous and pulsatile flow
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Thank you for your attention !
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Dominique Hella, ECCP