Datt Bharat, Nguyen Moui B, Plancher Gary, Ruzmetov Mark, O'Brien Michael, Kube Alicia, Munro Hamish M, Pourmoghadam Kamal K, DeCampli William M
The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida.
J Extra Corpor Technol. 2017 Mar;49(1):36-43.
Centrifugal pumps are considered to be less destructive to blood elements (1) when compared to roller pumps. However, their large prime volumes render them unsuitable as arterial pumps in heart lung machine (HLM) circuitry for children. In November of 2014, the circuit at Arnold Palmer Hospital, a Biomedicus BP-50 with kinetic assist venous drainage (KAVD) and 1/4″ tubing was converted to a roller pump in the arterial position with gravity drainage. Vacuum-assisted venous drainage (VAVD) was mounted on the HLM as a backup, but not used. Tubing was changed to 3/16″ in the arterial line in patients <13 kg. A retrospective study with a total of 140 patients compared patients placed on cardiopulmonary bypass (CPB) with Biomedicus centrifugal pumps and KAVD (Centrifugal Group, = 40) to those placed on CPB with roller pumps and gravity drainage (Roller Group, = 100). Patients requiring extra-corporeal membrane oxygenation (ECMO)/cardio-pulmonary support (CPS) or undergoing a hybrid procedure were excluded. Re-operation or circulatory arrest patients were not excluded. Prime volumes decreased by 57% from 456 ± 34 mL in the Centrifugal Group to 197 ± 34 mL in the Roller Group ( < .001). There was a corresponding increase in hematocrit (HCT) of blood primes and also on CPB. Intraoperative homologous blood transfusions also decreased 55% from 422 mL in the Centrifugal Group to 231 mL in the Roller Group ( < .001). The Society of Thoracic Surgeons--European Association for Cardio-Thoracic Surgery (STAT) categorized intubation times and hospital length of stay (LOS) for all infants showed a trend toward reduction, but was not statistically significant. Overall mortality was 5% utilizing the centrifugal configuration and 0% in the roller pump cohort. We demonstrated that the transition to roller pumps in the arterial position of the HLM considerably reduced our priming volume and formed a basis for a comprehensive blood conservation program. By maintaining higher HCTs on CPB, we were able to reduce intraoperative homologous blood transfusions.
与滚压泵相比，离心泵被认为对血液成分的破坏较小(1)。然而，它们的大预充量使其不适用于儿童心肺机(HLM)回路中的动脉泵。2014年11月，阿诺德·帕尔默医院的回路，一台带有动力辅助静脉引流(KAVD)和1/4英寸管道的Biomedicus BP - 50在动脉位置被转换为滚压泵，采用重力引流。真空辅助静脉引流(VAVD)作为备用装置安装在HLM上，但未使用。体重<13kg的患者，动脉管路的管道改为3/16英寸。一项总计140例患者的回顾性研究，将使用Biomedicus离心泵和KAVD进行体外循环(CPB)的患者(离心泵组，n = 40)与使用滚压泵和重力引流进行CPB的患者(滚压泵组，n = 100)进行比较。需要体外膜肺氧合(ECMO)/心肺支持(CPS)或接受杂交手术的患者被排除。再次手术或循环骤停患者未被排除。预充量从离心泵组的456±34mL减少了57%，降至滚压泵组的197±34mL(p <.001)。预充血液的血细胞比容(HCT)以及CPB期间的HCT相应增加。术中同源输血也从离心泵组的422mL减少了55%，降至滚压泵组的231mL(p <.001)。胸外科医师协会-欧洲心胸外科协会(STAT)对所有婴儿的插管时间和住院时间(LOS)进行分类，显示有减少趋势，但无统计学意义。使用离心泵配置的总体死亡率为5%，滚压泵队列的死亡率为0%。我们证明，在HLM的动脉位置转换为滚压泵可显著减少我们的预充量，并为全面的血液保护计划奠定了基础。通过在CPB期间维持较高的HCT，我们能够减少术中同源输血。
