Stammers Alfred H, Miller Randi, Francis Stephen G, Fuzesi Laszlo, Nostro Anthony, Tesdahl Eric
SpecialtyCare, Nashville, Tennessee.
Chester County Hospital, West Chester, Pennsylvania.
J Extra Corpor Technol. 2017 Jun;49(2):81-92.
New generation oxygenators incorporate arterial line filtration either sequential to, or directly in, the gas exchange module. This unique design may affect gas exchange performance by altering the operational characteristics of the device. The present study was designed to evaluate three oxygenators in a clinical setting using a goal-directed perfusion algorithm during cardiopulmonary bypass (CPB). After institutional review board approval, 60 adult patients undergoing cardiac surgery for acquired heart disease were matched for disease state and body size into three groups based on oxygenator type: Terumo SX18 ( = 20), Terumo FX15 ( = 20), and LivaNova Inspire6F 6 Dual ( = 20). An external arterial line filter was used with the FX15, whereas the SX18 and Inspire6F had integrated arterial filters. All perfusion, anesthetic and postoperative care management was standardized using institutional goal-directed patient management processes. Data were collected and stored according to quality improvement guidelines. There were no differences in demographics or type of surgical procedure performed among groups. The Inspire6F patients required lower fraction of inspired oxygen values as compared to the SX18 (67.9% ± 6.2% vs. 75.4% ± 6.5%, < .005) and FX15 (79.1% ± 8.4%, < .0001) groups. Arterial oxygen content and oxygen delivery were slightly higher in the FX15 group as compared to SX18 (13.1 ± 1.4 mL O/dL vs. 12.4 ± 1.1 mL O/dL, 611.1 ± 150.4 mL O vs. 528.2 ± 102.3 mL O, < .05). The FX15 patients had significantly higher CPB hematocrits compared to SX18 patients (30.3% ± 3.9% vs. 27.7% ± 2.6%, < .05), but were not different when compared to the Inspire6F group (28.8% ± 3.5%, < .50). There were no differences in intraoperative transfusion rates, but a higher percent of patients received postoperative transfusions in the SX18 group as compared to either FX15 or Inspire6F groups ( < .039). There were no differences in postoperative morbidity or complications in any group. In conclusion, the use of the SX18 was comparable to newer generation oxygenators in regard to gas exchange performance and the degree of hemodilution.
新一代氧合器在气体交换模块之前或直接在其中合并了动脉管路过滤功能。这种独特的设计可能会通过改变设备的运行特性来影响气体交换性能。本研究旨在评估三种氧合器在体外循环（CPB）期间使用目标导向灌注算法的临床环境中的性能。经机构审查委员会批准，60例因后天性心脏病接受心脏手术的成年患者根据疾病状态和身体大小，按照氧合器类型分为三组：Terumo SX18（n = 20）、Terumo FX15（n = 20）和LivaNova Inspire6F 6 Dual（n = 20）。FX15使用了外部动脉管路过滤器，而SX18和Inspire6F具有集成动脉过滤器。所有灌注、麻醉和术后护理管理均使用机构目标导向的患者管理流程进行标准化。数据根据质量改进指南进行收集和存储。各组之间在人口统计学或所进行的手术类型方面没有差异。与SX18组（67.9%±6.2%对75.4%±6.5%，P <.005）和FX15组（79.1%±8.4%，P <.0001）相比，Inspire6F组患者所需的吸入氧分数值较低。与SX18组相比，FX15组的动脉血氧含量和氧输送量略高（13.1±1.4 mL O₂/dL对12.4±1.1 mL O₂/dL，611.1±150.4 mL O₂对528.2±102.3 mL O₂，P <.05）。与SX18组患者相比，FX15组患者的CPB血细胞比容显著更高（30.3%±3.9%对27.7%±2.6%，P <.05），但与Inspire6F组相比无差异（28.8%±3.5%，P <.50）。术中输血率没有差异，但与FX15组或Inspire6F组相比，SX18组术后接受输血的患者百分比更高（P <.039）。任何组在术后发病率或并发症方面均无差异。总之，就气体交换性能和血液稀释程度而言，SX18的使用与新一代氧合器相当。
