Hjärpe Anders K, Jeppsson Anders, Lannemyr Lukas, Pernbro Fredrik, Hesse Camilla, Romlin Birgitta
Department of Perfusion, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Interdiscip Cardiovasc Thorac Surg. 2024 Sep 4;39(3). doi: 10.1093/icvts/ivae156.
Extracorporeal circulation induces pronounced effects on haemostasis and rheology. To study these, an ex vivo simulation model is an attractive alternative but often requires large amounts of blood. We sought to create a miniaturized roller pump circuit requiring minimal amounts of blood and to test if the circuit could be used to compare coagulation, platelet function and blood rheology between a dextran-based and a crystalloid-based priming solution.
A miniaturized roller pump circuit requiring only 27 ml of blood was created. Blood samples from 8 cardiac surgery patients were mixed with either a dextran-based or a crystalloid-based solution and circulated for 60 min. Coagulation was assessed by rotational thromboelastometry, and platelet function by impedance aggregometry and flow cytometry, before and at 5 and 60 min of circulation.
A time-dependent impairment of coagulation was observed in both groups. Maximum clot firmness was lower with dextran-based than with crystalloid-based priming at 5 min (HEPTEM 37 ± 4 vs 43 ± 4 mm, P < 0.001; EXTEM 37 ± 4 vs 43 ± 4 mm, P < 0.001; FIBTEM 3 ± 2 vs 9 ± 2 mm, P < 0.001) and at 60 min (HEPTEM 29 ± 9 vs 38 ± 5 mm, P < 0.001; EXTEM 30 ± 7 vs 39 ± 5 mm, P < 0.001; FIBTEM 3 ± 2 vs 8 ± 3 mm, P = 0.002). The EXTEM clotting time was longer with dextran-based solution at 5 (109 ± 19 vs 63 ± 7 sec, P < 0.001) and at 60 min (176 ± 72 vs 73 ± 7 sec, P = 0.004).
The novel miniaturized roller pump circuit can be used to mimic extracorporeal circulation for selected research questions. Dextran-based priming caused a significant impairment in haemostasis compared with a standard crystalloid solution.
体外循环对止血和血液流变学有显著影响。为研究这些影响，体外模拟模型是一种有吸引力的替代方法，但通常需要大量血液。我们试图创建一种所需血液量最少的小型化滚压泵回路，并测试该回路是否可用于比较基于右旋糖酐的预充液和基于晶体液的预充液之间的凝血、血小板功能和血液流变学。
创建了一种仅需27毫升血液的小型化滚压泵回路。将8名心脏手术患者的血样与基于右旋糖酐的溶液或基于晶体液的溶液混合，并循环60分钟。在循环前、5分钟和60分钟时，通过旋转血栓弹力图评估凝血情况，通过阻抗聚集法和流式细胞术评估血小板功能。
两组均观察到凝血功能随时间的损害。在5分钟时，基于右旋糖酐的预充液的最大血凝块硬度低于基于晶体液的预充液（HEPTEM：37±4 vs 43±4毫米，P<0.001；EXTEM：37±4 vs 43±4毫米，P<0.001；FIBTEM：3±2 vs 9±2毫米，P<0.001），在60分钟时也是如此（HEPTEM：29±9 vs 38±5毫米，P<0.001；EXTEM：30±7 vs 39±5毫米，P<0.001；FIBTEM：3±2 vs 8±3毫米，P = 0.002）。基于右旋糖酐的溶液在5分钟时（109±19 vs 63±7秒，P<0.001）和60分钟时（176±72 vs 73±7秒，P = 0.004）的EXTEM凝血时间更长。
新型小型化滚压泵回路可用于模拟体外循环以解决特定研究问题。与标准晶体液相比，基于右旋糖酐的预充液对止血有显著损害。
