Beckman Roland Ryan, Gisner Carl, Evans Ed
College of Health Sciences, Midwestern University, Glendale, Arizona, USA.
J Extra Corpor Technol. 2009 Sep;41(3):161-5.
Gaseous microemboli (GMEs) have been connected to neurologic impairment and other ischemic complications after surgery. The components of the extracorporeal circuit (ECC) have a large influence on GME production. This in vitro study investigates the use of carbon dioxide flushing of the 38-microm Medtronic Affinity CB351 and 38-microm Medtronic Affinity 351 arterial line filters (ALFs) to decrease GMEs and time for air to clear the ALE An adult circuit was implemented with a silicone oxygenator for vacuum-assisted gas removal and to reduce air before ALE The 48 filters were separated into four equal groups: flushed coated and non-coated and non-flushed coated and non-coated. Carbon dioxide flushing was performed at 6 L/min for 3 minutes. ALFs were retrograde primed at 200 mL/min. An Emboli Detection and Classification Quantifier (EDAC) was used to gather data. The average total emboli and time to clear (seconds) for flush coated were 20.25 +/- 16.78 and 142.17 +/- 174.80 seconds, respectively, flushed non-coated were 30.5 +/- 34.65 and 124.17 +/- 131.40 seconds, non-flushed coated were 162.08 +/- 79.90 and 390.42 +/- 84.36 seconds, and non-flushed non-coated were 163.67 +/- 212.67 and 305.92 +/- 179.36 seconds. Flushed filters had an average total emboli count of 25.375 +/- 27.14 and an average time to clear of 13.167 +/- 151.51 seconds. Non-flushed filters had an average total emboli count of 162.875 +/- 157.11 and an average time to clear of 348.167 +/- 143.70 seconds. Coated and non-coated filters for total emboli and time to clear had p values of .86 and .24, respectively. Flushed and non-flushed filters had total emboli and time to clear p values of < .001 and < .001, respectively. No significant difference was found between coated and non-coated filters involving total embolic count and time to clear. A significant difference was found in total embolic count and time to clear between flushed and non-flushed filters. This study shows that fewer emboli and faster embolic clearance time correlate with carbon dioxide flushing of the ALE.
气体微栓子（GMEs）与术后神经功能损害及其他缺血性并发症有关。体外循环（ECC）组件对GME的产生有很大影响。本体外研究探讨了使用二氧化碳冲洗38微米的美敦力Affinity CB351和38微米的美敦力Affinity 351动脉管路过滤器（ALFs）以减少GMEs以及空气清除动脉管路的时间。使用硅胶氧合器构建成人体外循环，用于真空辅助气体清除并在动脉管路前减少空气。48个过滤器被分成四组：冲洗的有涂层和无涂层的，以及未冲洗的有涂层和无涂层的。以6 L/分钟的速度进行3分钟的二氧化碳冲洗。动脉管路过滤器以200 mL/分钟的速度逆行预充。使用栓子检测与分类定量器（EDAC）收集数据。冲洗的有涂层过滤器的平均总栓子数和清除时间（秒）分别为20.25±16.78和142.17±174.80秒，冲洗的无涂层过滤器为30.5±34.65和124.17±131.40秒，未冲洗的有涂层过滤器为162.08±79.90和390.42±84.36秒，未冲洗的无涂层过滤器为163.67±212.67和305.92±179.36秒。冲洗的过滤器平均总栓子数为25.375±27.14，平均清除时间为13.167±151.51秒。未冲洗的过滤器平均总栓子数为162.875±157.11，平均清除时间为348.167±143.70秒。有涂层和无涂层过滤器在总栓子数和清除时间方面的p值分别为0.86和0.24。冲洗和未冲洗的过滤器在总栓子数和清除时间方面的p值分别<0.001和<0.001。在总栓子数和清除时间方面，有涂层和无涂层过滤器之间未发现显著差异。冲洗和未冲洗的过滤器在总栓子数和清除时间方面存在显著差异。本研究表明，较少的栓子和更快的栓子清除时间与动脉管路的二氧化碳冲洗相关。
