Dickinson Timothy A, Riley Jeffrey B, Crowley Jeffrey C, Zabetakis Paul M
Fresenius Medical Care Extracorporeal Alliance, San Diego, California, USA.
J Extra Corpor Technol. 2006 Sep;38(3):206-13.
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 extracorporeal 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.
神经功能障碍是成人心脏手术常见的并发症。在体外循环期间检测到的脑气态微栓子（GME）与成人心脏手术后的认知功能障碍有关。先前的几项研究表明，构成体外循环（ECC）的组件会影响ECC消除空气的能力。研究了四个制造商常用的ECC的空气分离能力差异。在临床相关条件下，对Cobe心血管公司、Gish生物医学公司、美敦力公司和泰尔茂心血管系统公司的ECC的空气分离能力进行了体外研究。引入团注和持续静脉空气，并测量（使用栓子检测装置）按大小、时间和数量输出的GME模式，并进行统计分析。描绘经过时间、GME大小和气泡数量的图表有助于直观地对ECC的空气处理性能进行排名。所测试的ECC之间存在显著的空气处理差异。总体而言，盲法结果显示，ECC A和ECC C清除的悬浮GME明显（p<0.001）多于ECC B和ECC D。在50 mL静脉室内空气团注和100 mL/min脉冲空气挑战中，与ECC A和ECC C相比，ECC B和ECC D允许更多的GME通过（p<0.001）。例如，在2小时的泵运行中，在100 mL/min的静脉室内空气夹带期间，ECC C将产生480个潜在的高强度瞬态信号（HITS）相比于ECC B的9600个。来自四个不同制造商的ECC之间存在实质性和显著的空气处理差异。这项工作的结果有助于客观地描述ECC的空气分离能力。这些额外信息为临床医生提供了一个机会，有可能将动脉空气栓塞及其相关有害神经影响的风险降至最低，同时使临床医生能够做出更明智的消费决策。
