ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
Department for Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Artif Organs. 2021 Jan;45(1):46-54. doi: 10.1111/aor.13763. Epub 2020 Jul 28.
Hemolysis in cardiac surgery is often related to the contact of blood with air or artificial surfaces. Variations of negative pressure in the suction cannulas may represent an additional factor. Limited data exist on the contribution of a roller pump-assisted (RPA) cardiotomy suction unit to hemolysis. Elevation of free hemoglobin (fHb) following air suction (AS) or suction tip occlusion (STO) events of a pump-assisted cardiotomy suction unit was investigated in a mock circuit filled with blood from slaughtered domestic pigs. AS-associated hemolysis was measured over 240 minutes with 2 minutes of AS occurring every 10 minutes. STO-associated hemolysis was analyzed over 80-minute periods: configuration 1 (c1) comprised a cycle of 20 minutes (min) occlusion and 60 minutes RPA flow (20/60 minutes); c2 comprised 20 cycles of 1/3 minutes; c3 comprised 40 cycles of 0.5/1.5 minutes; and c4 comprised 80 cycles of 0.25/0.75 minutes. The AS setup did not lead to significant hemolysis after 2 (P = .97), 3 (P = .40) or 4 (P = .11) hours. The STO setup showed the greatest hemolysis (ΔfHb of 30 mg/dL) in c1 after 20 minutes. ΔfHb was different in c1 from all other configurations at 20 minutes (P < .0001) and 80 minutes (P < .05). Ex vivo generation of large negative pressures by STO events is the main cause of cardiotomy suction-associated hemolysis. The clinical relevance of this mechanism needs further investigations.
体外循环心内直视手术中溶血常与血液接触空气或人工表面有关。吸引管内负压的变化可能是另一个因素。目前关于滚压泵辅助（RPA）心内吸引器对溶血的影响的数据有限。本研究旨在模拟心内吸引器在充满猪血的体外循环回路中进行空气抽吸（AS）或吸引尖端阻塞（STO）事件时，测量游离血红蛋白（fHb）的变化。AS 相关溶血在 240 分钟内进行测量，每隔 10 分钟进行 2 分钟的 AS。STO 相关溶血在 80 分钟的时间段内进行分析：配置 1（c1）包括 20 分钟（min）阻塞和 60 分钟 RPA 流动（20/60 分钟）的循环；c2 包括 20 个 1/3 分钟的循环；c3 包括 40 个 0.5/1.5 分钟的循环；c4 包括 80 个 0.25/0.75 分钟的循环。AS 设置在 2 小时（P =.97）、3 小时（P =.40）或 4 小时（P =.11）后没有导致显著溶血。在 20 分钟时，STO 设置在 c1 中显示出最大的溶血（ΔfHb 为 30mg/dL）。在 20 分钟和 80 分钟时，c1 中的 ΔfHb 与所有其他配置均不同（P <.0001 和 P <.05）。STO 事件产生的大负压是心内吸引相关溶血的主要原因。该机制的临床意义需要进一步研究。
