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PubMed2003

[The intervention of reduced glutathione in neutrophil activation in the process of extracorporeal circulation].

OBJECTIVE: To study the intervention of reduced glutathione for neutrophil activation in the process of extracorporeal circulation. METHOD: 20 congenital heart disease children aged from 6 to 12 years were selected randomly, divided into control group and interventional group, patients of interventional group were added reduced glutathione (30 mg/kg) in priming fluid, then phlebotomized on the time of 24 hours before operation, 20 minutes after CPB, rewarming, the end of CPB, 4 hours after operation, 24 hours after operation. After separated neutrophil, we distilled nuclear protein and mensurated the activation of nuclear factor-kappaB by EMSA, assayed the expression of ICAM-1. by immunohistochemistry. RESULTS: Neutrophil nuclear factor-kappaB has been activated on the time of 20 minutes after CPB, arrives at the top on the time of rewarming, and resumes 24 hours after operation; ICAM-1 expresses on the time of rewarming, arrives at the top 4 hours after operation in control group. The data of interventional group is lower than the control group. CONCLUSION: Neutrophil nuclear factor-kappaB is activated and ICAM-1 is expressed in the process of extracorporeal circulation and play an important role in the inflammatory response happening in extracorporeal circulation, which could be relieved by reduced glutathione.

Cardiopulmonary Bypass↗
PubMed1977

[Osmolar and free water clearance as renal function test during extracorporeal circulation with parcial and total hemodilution (author's transl)].

Four groups of dogs are subjected to extracorporeal circulation. Total hemodilution is used in groups I and II, either in normothermia or moderate hypothermia at 30 degrees C. Partial hemodilution is used in groups III and IV with identical temperature variations. The animals are kept under extracorporeal circulation for 120 min. Osmolar and free water clearance are measured at basal conditions after 40, 80 and 120 min. The present results show that total hemodilution should be used in those patients subjected to extracorporeal circulation where renal function has been previously disturbed.

Acute Kidney Injury↗
PubMed2003

Nuclear factor kappaB mediates a procoagulant response in monocytes during extracorporeal circulation.

OBJECTIVE: The objective of this study was to examine the mechanism of procoagulant activity and inhibition in whole blood during extracorporeal circulation. METHODS: In this study we examine the development of procoagulant activity and monocyte activation in heparinized whole blood passing through a closed circuit consisting of a pump and silicone envelope membrane oxygenator for 6 hours. RESULTS: Anaphylatoxins, C3a and C5a, determined by means of enzyme-linked immunosorbant assay, appeared in the blood within 30 minutes of circulation. Circulated blood developed a marked potential for coagulation demonstrated in a 1-step clotting assay that reached maximal activity by 4 hours of circulation. This procoagulant activity was neutralized by anti-tissue factor antibody, suggesting a prominent role for the extrinsic pathway in pump-induced intravascular coagulation. Isolation of monocytes from circulated blood revealed that tissue factor expression is upregulated on the cell surface. Furthermore, we observed nuclear factor kappaB nuclear translocation in monocytes from blood passing through the circuit, suggesting that tissue factor expression was due to monocyte stimulation and transcriptional activation of the tissue factor gene. Tissue factor expression resulted in an approximately 30-fold increase in thrombin generation. Monocyte nuclear factor kappaB activation, monocyte tissue factor expression, thrombin generation, and the procoagulant activity of blood in extracorporeal circulation were all blocked by the proteasome inhibitor MG132. CONCLUSIONS: We conclude that intravascular tissue factor expression during extracorporeal circulation of blood is due to nuclear factor kappaB-mediated activation of monocytes (possibly by complement), which can be controlled pharmacologically.

Blood Coagulation↗
PubMed1996

[Successful resuscitation of a hypothermic patient with extracorporeal circulation--a case report].

A case of cardiopulmonary arrest due to accidental hypothermia and its successful therapy is described. A 46-year-old man with deep accidental hypothermia (25.3 degrees C esophageal) was found outside showing respiratory and cardiac arrest. Resuscitation was immediately started and continuously performed during the transport to the University Hospital of Rostock, where a treatment with extracorporeal circulation was possible. After cardiopulmonary resuscitation for 120 minutes, the patient could finally be connected to the extracorporeal circulation. Over a period of 130 minutes the patient could be rewarmed up to a body temperature of 36.0 degrees C. The following therapy was complicated by the development of an alcoholic delirium, which was treated by clomethiazol, droperidol and clonidin infusion. After seven days of intensive therapy, he recovered completely and could be transferred from the intensive care unit to the department of psychiatry without neurological deficits showing only healing of frostbite of the feet. Based on this case report, the use of extracorporeal circulation for adequate rewarming in combination with cardiopulmonary resuscitation is described. Compared to other therapeutic measures such as peritoneal dialysis or veno-venous haemofiltration treatment with extracorporeal circulation is the method of choice.

Cardiopulmonary Resuscitation↗
PubMed2006

Hyperbilirubinemia after extracorporeal circulation surgery: a recent and prospective study.

AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 micromol/L. Several perioperative parameters were compared by logistic regression between hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality. RESULTS: Overall incidence of postoperative hyperbilirubinemia was 25.3% (98/386). In patients with postoperative hyperbilirubinemia, 56.2% reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3% on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P<0.01), longer duration of mechanical ventilation (P<0.05) and longer ICU stay time (P<0.05). Preoperative total bilirubin concentration, preoperative right atrium pressure, numbers of valves replaced and of blood transfusion requirement were identified as important predictors for postoperative hyperbilirubinemia. CONCLUSION: Early postoperative hyperbilirubinemia after modern extracorporeal circulation is mainly caused by an increase in both conjugated and unconjugated bilirubin, and is associated with a high mortality. Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial pressure, numbers of valve replacement procedures, and the amount of blood transfusion requirement during and shortly after surgery. We suggest that postoperative hyperbilirubinemia is a multifactorial process, which is caused by both the impaired liver function of bilirubin transport and the increased production of bilirubin from haemolysis.

Adolescent↗
PubMed1999

Anticoagulation with prostaglandins during extracorporeal circulation.

This paper reviews pathophysiological processes occurring after contact of blood with artificial surfaces and the predominant role of platelets in the genesis of extracorporeal thrombosis. Bleeding complications are common during conventional heparin anticoagulation, and both clinical and experimental evidence suggests that the efficacy of heparin as an anticoagulant is compromised by its relative ineffectiveness towards platelets. Consequently, drugs that inhibit interaction between platelets and artificial membranes have been introduced as an alternative anticoagulant strategy. This paper reviews studies on the use of short-acting antiplatelet prostaglandins such as prostacyclin and prostaglandin E1 alone or in combination with heparin during various forms of extracorporeal circulation such as cardiopulmonary bypass, haemodialysis, continuous haemofiltration, membrane oxygenation, ventricular assist devices, and haemoperfusion. Temporary paralysis of platelet function with antiplatelet prostaglandins has been effective in controlling platelet-surface interaction and reducing bleeding complications and morbidity during and after extracorporeal circulation. By inhibiting the formation of fibrin, leukocyte and platelet-based microaggregates and cytoprotective actions, prostaglandins have been shown to prevent renal, neurologic, and pulmonary dysfunction after extracorporeal circulation. Prostaglandins were most effective in increasing the biocompatibility of extracorporeal systems when they were administered as a supplement to but not as a substitute for heparin. The use of prostaglandins alone should be reserved for patients who are resistant to heparin or heparin-induced thrombocytopenia.

Anticoagulants↗
PubMedDate not supplied

Flush perfusion using Euro-Collins solution vs cooling by means of extracorporeal circulation in heart-lung preservation.

Single-flush perfusion using modified Euro-Collins solution and donor cooling by extracorporeal circulation represent two concepts of lung preservation currently in use for on-site heart-lung transplantation. The question of which technique is better for safe clinical application of heart-lung transplantation, including extended periods of ischemia and distant organ procurement, currently remains undetermined. Eighteen mongrel dogs, divided in three groups, underwent left lung, heterotopic heart transplantation, leaving the right lung and heart of the recipient in place. Donor organs were obtained from size-matched dogs. In all groups, myocardial preservation was achieved using 10 ml/kg cold potassium cardioplegia. Following flush perfusion of the lung (Euro-Collins solution, 60 ml/kg), six dogs were immediately transplanted (group I). Using the same preservation, organs were stored for 6 hours at 4 degrees C in group II. In group III, organs were cooled using extracorporeal circulation until reaching a rectal temperature of 16 degrees C, harvested, and thereafter stored as in group II. After transplantation, blood supply of the donor heart was assured by selective drainage of the superior vena cava into the right side of the donor heart. Outflow was obtained by end-to-side anastomosis of donor and recipient aorta. The dogs were kept anesthetized, and both lungs were ventilated selectively with an FiO2 of 0.4 for 20 hours or until death. During the postoperative course, the donor heart pumped about one third of the entire cardiac output in all groups. The lowest pulmonary vascular resistance of the transplanted lung was observed in group III. Oxygenation of the transplanted lung revealed no impairment in group I compared with the pretransplant values. By contrast, groups II and III showed a slight decrease of oxygenation within acceptable limits. We therefore conclude that both methods of cardiopulmonary preservation evaluated may allow for an extended ischemic time of up to 6 hours before heart-lung transplantation. Pulmonary vascular resistance was significantly lower in the group preserved by extracorporeal circulation, possibly reflecting superior preservation of lung function by this method.

Animals↗
PubMed1985

Hydroxyethylrutosides during extracorporeal circulation: effect on erythrocyte deformability.

The effect of hydroxyethylrutosides (HR) on erythrocyte deformability was studied in 13 adult patients subjected to extracorporeal circulation, in seven cases for single valve replacement and in six for coronary bypass operations. A single dose of 1.5 g HR was given by slow intravenous injection immediately before the cardiopulmonary bypass. The controls were 13 patients undergoing the same operations but without HR. In the HR-medicated valve group there was only 3% decrease in erythrocyte deformability following extracorporeal circulation, in contrast to a 41% (p less than 0.01) decrease in the control valve group. Among the coronary patients there was no such difference between the HR and the control groups, with deformability decreasing by 21 and 26%, respectively (both significant, p less than 0.05). HR administered before extracorporeal circulation thus had significant prophylactic effect on red cell deformability in patients undergoing valve replacement. Such beneficial action may improve nutritional blood flow, thereby reducing the number of postoperative complications in various organs. With higher doses and/or longer periods of administration, a favorable effect of HR might be possible also in patients subjected to coronary surgery.

Aged↗
PubMed1992

[Effect of potassium canrenoate on serum magnesium levels after extracorporeal circulation].

Serum magnesium (Mg) levels were measured before and after operations involving extracorporeal circulation in thirty-five patients. Twenty patients were administered potassium canrenoate 200 mg/day from 2 days before operation to the 3rd postoperative day. Another 15 patients to whom there had been no administration of potassium canrenoate served as controls. We investigated the difference of serum Mg levels between the two groups. The serum Mg levels significantly decreased immediately after operations as compared to the values before surgery as from 1.9 +/- 0.2 to 1.5 +/- 0.2mEq/l (p less than 0.001) and from 1.8 +/- 0.2 to 1.4 +/- 0.2mEq/l (p less than 0.001) in the medicated and control groups, respectively. Serum Mg levels on the 2nd postoperative day recovered to within the normal range and it was significantly higher in the medicated group (1.7 +/- 0.2mEq/l versus 1.5 +/- 0.3mEq/l; p less than 0.05). Hypomagnesemia (Mg less than or equal to 1.2mEq/l) was found in seven patients (46.7%) in the control group and in two patients (10.0%) in the medicated group. Thus, there was a significant difference in the incidence of hypomagnesemia between the two groups (p less than 0.05). These results suggested that administration of potassium canrenoate is useful for keeping and improving serum Mg levels after extracorporeal circulation.

Adolescent↗
PubMed2003

History of extracorporeal circulation: the conceptional and developmental period.

The development of modern techniques in extracorporeal circulation is the result of the combined efforts of physiologists, physicians, and engineers. Early experimental work at the end of the 19th century was accomplished by physiologists, such as von Schröder, von Frey, and Gruber, as well as Jacobj. These scientists laid the foundation for three different artificial oxygenation devices for experimental isolated animal organ perfusion. The developed bubble, film, and isolated lung oxygenation methods developed were later used for the first clinical cardiopulmonary bypass procedures in humans. For continuous perfusion experiments, closed circulation circuits were put into use. In a second step, during the first half of the 20th century, scientists and physicians, such as Brukhonenko, Gibbon, Crafoord, Björk, and Jongbloed were working on the refinement of these methods for intended application during cardiovascular operations in humans. Refined bubble and film oxygenators together with the modern blood pumps in closed circulatory systems were assembled as pump oxygenators, later called heart-lung machines. They were used in the first clinical cases of extracorporeal circulation for heart surgery in the second half of the 20th century by Dennis, Dogliotti and Constantini, and Gibbon.

Animals↗
PubMed1990

Distant organ procurement in clinical lung- and heart-lung transplantation. Cooling by extracorporeal circulation or hypothermic flush.

The scarcity of suitable donors for single lung and heart-lung transplantation calls for methods of medium-term pulmonary preservation to allow for distant organ procurement. At our institution, the first five grafts (four heart-lung, one single lung) were cooled by means of a transportable extracorporeal circulation unit, while the last eight grafts (four heart-lung, four single lung) were flush-perfused with modified cold Euro-Collins solution. The technique of extracorporated circulation included aortic and right atrial cannulation and cooling to 12 degrees-14 degrees C (rectal temperature) using a bubble oxygenator. Bypass times ranged between 41 and 52 min. Following excision, the organs were transported in ice-cold donor blood for ischemic times from 171 to 310 min. For cold flush preservation, simultaneous coronary (cold St. Thomas's solution) and pulmonary artery perfusion (Euro-Collins solution, 50 ml/kg over 4 min) were initiated simultaneously. The organs were transported in cold Euro-Collins solution for ischemic times of 175 to 270 min. In heart-lung transplantations the first postoperative arterial PO2 upon arrival at the intensive care unit was 120 +/- 38 Torr in the extracorporeal circulation and 140 +/- 38 Torr in the Euro-Collins solution group. Six of eight patients were extubated within 48 h after cardiopulmonary grafting. We conclude that pulmonary function following heart-lung or single lung preservation with simple hypothermic flush is as good or better than that following extracorporeal circulation. Since distant organ retrieval is much more convenient without the latter, preservation using Euro-Collins solution is preferred.

Adolescent↗
PubMedDate not supplied

Is heparin necessary for extracorporeal circulation?

To explore the possibility of extracorporeal circulation (ECC) without heparin, we performed veno-arterial extracorporeal membrane oxygenator procedures for a five hour period on a total of 15 rabbits in three groups. Blood flow rates were maintained at 125 ml/min with a standard roller pump through 1/4 inch PVC tubing and a 0.4 m2 SciMed membrane oxygenator. The rabbits in Group 1 received a standard dose of heparin, while no form of anticoagulation was used in Group 2. The tubing and membrane surfaces in Group 3 were modified by a glutaraldehyde crosslinked albumin-heparin complex with no systemic heparinization. Blood samples were obtained for activated clotting time, platelet count, and blood gas determinations. Circuits were evaluated for thrombosis, and samples of lung and kidney were examined histologically for emboli. There were no statistically significant differences among the three groups for any of the quantitative parameters. Moderate thrombus formation was visually detected in some areas of stagnation in the nonheparinized systems, while the albumin coating appeared to inhibit thrombus formation in regions of moderate and high blood flow. These results do not reflect any significant benefit of either the albumin-heparin coating or systemic heparinization during short-term ECC.

Albumins↗
PubMed1998

Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies.

BACKGROUND: Despite recent rediscovery of beating heart cardiac surgical techniques, extracorporeal circulation remains appropriate for most heart operations. To minimize deleterious effects of cardiopulmonary bypass, antiinflammatory strategies have evolved. METHODS: Four state-of-the-art strategies were studied in a prospective, randomized, preoperatively risk stratified, 400-patient study comprising primary (n = 358), reoperative (n = 42), coronary (n = 307), valve (n = 27), ascending aortic (n = 9), and combined operations (n = 23). Groups were as follows: standard, roller pump, membrane oxygenator, methylprednisolone (n = 112); aprotinin, standard plus aprotinin (n = 109); leukocyte depletion, standard plus a leukocyte filtration strategy (n = 112); and heparin-bonded circuitry, centrifugal pumping with surface modification (n = 67). RESULTS: Analysis of variance, linear and logistic regression, and Pearson correlation were applied. Actual mortality (2.3%) was less than half the risk stratification predicted mortality (5.7%). The treatment strategies effectively attenuated markers of the inflammatory response to extracorporeal circulation. Compared with the other groups the heparin-bonded circuit had highly significantly decreased complement activation (p = 0.00001), leukocyte filtration blunted postpump leukocytosis (p = 0.043), and the aprotinin group had less fibrinolysis (p = 0.011). Primary end points, length of stay, and hospital charges, were positively correlated with operation type, age, pump time, body surface area, stroke, pulmonary sequelae, predicted risk for stroke, predicted risk for mortality, and risk strata/treatment group interaction (p = 0.0001). In low-risk patients, leukocyte filtration reduced length of stay by 1 day (p = 0.02) and mean charges by $2,000 to $6,000 (p = 0.05). For high-risk patients, aprotinin reduced mean length of stay up to 10 fewer days (p = 0.02) and mean charges by $6,000 to $48,000 (p = 0.0007). CONCLUSIONS: These pharmacologic and mechanical strategies significantly attenuated the inflammatory response to extracorporeal circulation. This translated variably into improved patient outcomes. The increased cost of treatment was offset for selected strategies through the added value of significantly reduced risk.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1963

ACTIVATION OF COAGULATION AND FIBRINOGEN LOSS AFTER USING AN EXTRACORPOREAL CIRCULATION.

Alterations of the coagulation potential of heparinized blood after using an extracorporeal circulation have been studied by means of a toluidine blue-calcium chloride reagent. This technique was originally used to detect the effect of activation by contact on the coagulation mechanism in heparinized blood. It has been shown that it also detects, in the presence of heparin, the clotpotentiating effect of blood cell contents liberated in vitro by mechanical trauma to blood. Variable destruction of platelets, red cells, and white cells occurred in heparinized sheep blood recirculated in a heart-lung machine in vitro. This was accompanied by increased clotting potential. Complete coagulation was prevented by heparin and fibrinogen levels remained unaltered. Similar enhancement of the coagulation potential and destruction of blood cells were detected in the blood of heparinized patients and sheep after perfusion for open-heart surgery. The coagulation changes were usually transient, and impaired coagulation associated with significant fibrinogen loss was detected in most samples taken after the neutralization of heparin. It is suggested that the coagulation changes are due to activation by contact of the coagulation mechanism during perfusion and to the clot-accelerating effect of blood cell contents. The results support the hypothesis that coagulation defects and fibrinogen loss after using an extracorporeal circulation are due, at least in part, to intravascular coagulation. This is thought to occur, especially during neutralization of heparin, while the coagulation mechanism is hyperactive.

Aminocaproates↗
PubMedDate not supplied

[Conduction disorders after cardiac surgery with extracorporeal circulation].

Two-hundred-fifty-eight patients who had cardiac surgery with extracorporeal circulation were studied to determine the frequency and significance of conduction disturbances. Fifty-eight (34%) developed new postoperative conduction defects. Seventeen patients developed new conduction alterations after coronary artery bypass graft. The most common disturbance was transient bifascicular block (right bundle branch block and anterior subdivision block of the left bundle branch of His) (p less than 0.01). After valvular surgery twenty-one patients developed conduction defects. Of those the most common disturbance was high degree AV block (57%). The authors found no relation between the AV block and the number of valves operated on or type of valvular surgery. After congenital heart surgery, twenty patients developed conduction defects. The most common defect was high degree AV block. The frequency of complete heart block was higher after the closure of atrial septal defects (P less than 0.01). None of the conduction defects were related to the amount of time the patient was exposed to extracorporeal circulation or to postoperative myocardial infarction. All conduction defects were transient except complete heart block in some patients with ventricular septal defect surgery. In this study there were no hemodynamic complications or mortality associated with the conduction disturbances.

Adult↗
PubMed2006

Hearing loss in patients undergoing coronary artery bypass grafting with or without extracorporeal circulation.

BACKGROUND: Our aim was to investigate the differences in postoperative hearing thresholds in patients undergoing coronary artery bypass grafting with (Group I, n=20) or without (Group II, n=17) extracorporeal circulation. MATERIAL/METHODS: 37 patients undergoing coronary artery bypass grafting with or without extracorporeal circulation were prospectively evaluated in terms of hearing threshold changes with the intention of documenting hearing losses postoperatively. The t-test for two independent variables was used for statistical analysis. RESULTS: Hearing threshold changes were detected in 9 Group I patients (45%) and 3 Group II patients (17.65%). The difference between the two groups was statistically significant (p=0.0426). CONCLUSIONS: Postoperative hearing threshold changes, not necessarily revealed by clinical examinations, are encountered after coronary artery bypass grafting operations. Extracorporeal circulation usage seems to bring an additional risk in terms of hearing loss.

Audiometry, Evoked Response↗
PubMed1996

[Analysis of extracorporeal circulation on ventricular septal defect complicated by severe pulmonary hypertension in 53 children].

Extracorporeal circulation and myocardial protection in 53 children with ventricular septal defect associated with severe pulmonary hypertension were reported. The average aortic cross-clamping time was 45.5 minutes. The hearts were defibrillated spontaneously in 35 patients. We emphasized that full understanding of the pathophysiological characteristics of ventricular septal defect associated with severe pulmonary hypertension in children is fairly important to the use of various extracorporeal circulation techniques during surgical intervention.

Child↗