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  • 1.
    Broman, Lars Mikael
    et al.
    Karolinska Univ Hosp, ECMO Ctr Karolinska, Dept Pediat Perioperat Med & Intens Care, Eugeniavagen 23, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.;EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England..
    Prahl Wittberg, Lisa
    KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW. KTH, School of Engineering Sciences (SCI), Centres, BioMEx.
    Westlund, C. Jerker
    Karolinska Univ Hosp, ECMO Ctr Karolinska, Dept Pediat Perioperat Med & Intens Care, Eugeniavagen 23, S-17176 Stockholm, Sweden..
    Gilbers, Martijn
    Maastricht Univ, Dept Cardiothorac Surg, Heart & Vasc Ctr, Cardiovasc Res Inst Maastricht CARIM,Med Hosp, Maastricht, Netherlands.;Maastricht Univ, Dept Physiol, Maastricht, Netherlands..
    da Camara, Luisa Perry
    Hosp Curry Cabral, Ctr Hosp Lisboa Cent, Lisbon, Portugal..
    Swol, Justyna
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Paracelsus Med Univ, Dept Pulmonol, Intens Care Med, Nurnberg, Germany..
    Taccone, Fabio S.
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;ULB, Dept Intens Care, Hop Erasme, Brussels, Belgium..
    Malfertheiner, Maximilian V.
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Med Ctr Regensburg, Dept Internal Med Cardiol & Pneumol 2, Regensburg, Germany..
    Di Nardo, Matteo
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Childrens Hosp Bambino Gesu, IRCCS, Pediat Intens Care Unit, Rome, Italy..
    Vercaemst, Leen
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Hosp Gasthuisberg, Dept Perfus, Leuven, Belgium..
    Barrett, Nicholas A.
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Guys & St Thomas NHS Fdn Trust, Dept Crit Care, London, England.;Guys & St Thomas NHS Fdn Trust, Severe Resp Failure Serv, London, England..
    Pappalardo, Federico
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Vita Salute San Raffaele, Adv Heart Failure & Mech Circulatory Support Prog, Hosp San Raffaele, Milan, Italy..
    Belohlavek, Jan
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Charles Univ Prague, Gen Univ Hosp Prague, Dept Cardiovasc Med, Dept Med 2, Prague, Czech Republic.;Charles Univ Prague, Fac Med 1, Prague, Czech Republic..
    Mueller, Thomas
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Med Ctr Regensburg, Dept Internal Med Cardiol & Pneumol 2, Regensburg, Germany..
    Belliato, Mirko
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Fdn IRCCS Policlin San Matteo, UOC Anestesia & Rianimaz 1, Pavia, Italy..
    Lorusso, Roberto
    EuroElso, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Maastricht Univ, Dept Cardiothorac Surg, Heart & Vasc Ctr, Cardiovasc Res Inst Maastricht CARIM,Med Hosp, Maastricht, Netherlands..
    Pressure and flow properties of cannulae for extracorporeal membrane oxygenation I: return (arterial) cannulae2019In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, p. 58-64Article in journal (Refereed)
    Abstract [en]

    Adequate extracorporeal membrane oxygenation support in the adult requires cannulae permitting blood flows up to 6-8 L/minute. In accordance with Poiseuille's law, flow is proportional to the fourth power of cannula inner diameter and inversely proportional to its length. Poiseuille's law can be applied to obtain the pressure drop of an incompressible, Newtonian fluid (such as water) flowing in a cylindrical tube. However, as blood is a pseudoplastic non-Newtonian fluid, the validity of Poiseuille's law is questionable for prediction of cannula properties in clinical practice. Pressure-flow charts with non-Newtonian fluids, such as blood, are typically not provided by the manufacturers. A standardized laboratory test of return (arterial) cannulae for extracorporeal membrane oxygenation was performed. The aim was to determine pressure-flow data with human whole blood in addition to manufacturers' water tests to facilitate an appropriate choice of cannula for the desired flow range. In total, 14 cannulae from three manufacturers were tested. Data concerning design, characteristics, and performance were graphically presented for each tested cannula. Measured blood flows were in most cases 3-21% lower than those provided by manufacturers. This was most pronounced in the narrow cannulae (15-17 Fr) where the reduction ranged from 27% to 40% at low flows and 5-15% in the upper flow range. These differences were less apparent with increasing cannula diameter. There was a marked disparity between manufacturers. Based on the measured results, testing of cannulae including whole blood flows in a standardized bench test would be recommended.

  • 2.
    Broman, Lars Mikael
    et al.
    Karolinska Univ Hosp, Dept Pediat Perioperat Med & Intens Care, ECMO Ctr Karolinska, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.;EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England..
    Prahl Wittberg, Lisa
    KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW. KTH, School of Engineering Sciences (SCI), Centres, BioMEx.
    Westlund, C. Jerker
    Karolinska Univ Hosp, Dept Pediat Perioperat Med & Intens Care, ECMO Ctr Karolinska, S-17176 Stockholm, Sweden..
    Gilbers, Martijn
    Maastricht Univ, Hosp Med, Cardiovasc Res Inst Maastricht CARIM, Heart & Vasc Ctr,Dept Cardiothorac Surg, Maastricht, Netherlands.;Maastricht Univ, Dept Physiol, Maastricht, Netherlands..
    da Camara, Luisa Perry
    Hosp Curry Cabral, Ctr Hosp Lisboa Cent, Lisbon, Portugal..
    Westin, Jan
    Karolinska Univ Hosp, Dept Med Technol, Stockholm, Sweden..
    Taccone, Fabio Silvio
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;ULB, Dept Intens Care, Hop Erasme, Brussels, Belgium..
    Malfertheiner, Maximilian Valentin
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Med Ctr Regensburg, Dept Internal Med Cardiol & Pneumol 2, Regensburg, Germany..
    Di Nardo, Matteo
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Childrens Hosp Bambino Gesu, IRCCS, Pediat Intens Care Unit, Rome, Italy..
    Swol, Justyna
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Paracelsus Med Univ, Dept Pulmonol, Intens Care Med, Nurnberg, Germany..
    Vercaemst, Leen
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Hosp Gasthuisberg, Dept Perfus, Louven, Belgium..
    Barrett, Nicholas A.
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Guys & St Thomas NHS Fdn Trust, Dept Crit Care, London, England.;Guys & St Thomas NHS Fdn Trust, Severe Resp Failure Serv, London, England..
    Pappalardo, Federico
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Vita Salute San Raffaele, Hosp San Raffaele, Adv Heart Failure & Mech Circulatory Support Prog, Milan, Italy..
    Belohlavek, Jan
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Charles Univ Prague, Dept Med 2, Dept Cardiovasc Med, Gen Univ Hosp Prague, Prague, Czech Republic.;Charles Univ Prague, Fac Med 1, Prague, Czech Republic..
    Mueller, Thomas
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Univ Med Ctr Regensburg, Dept Internal Med Cardiol & Pneumol 2, Regensburg, Germany..
    Belliato, Mirko
    EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.;Fdn IRCCS Policlin San Matteo, UOC Anestesia & Rianimaz 1, Pavia, Italy..
    Lorusso, Roberto
    KTH, School of Engineering Sciences (SCI), Centres, BioMEx. KTH, School of Engineering Sciences (SCI), Centres, Linné Flow Center, FLOW. EuroELSO, Working Grp Innovat & Technol, Newcastle Upon Tyne, Tyne & Wear, England.
    Pressure and flow properties of cannulae for extracorporeal membrane oxygenation II: drainage (venous) cannulae2019In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, p. 65-73Article in journal (Refereed)
    Abstract [en]

    The use of extracorporeal life support devices such as extracorporeal membrane oxygenation in adults requires cannulation of the patient's vessels with comparatively large diameter cannulae to allow circulation of large volumes of blood (>5 L/min). The cannula diameter and length are the major determinants for extracorporeal membrane oxygenation flow. Manufacturing companies present pressure-flow charts for the cannulae; however, these tests are performed with water. Aims of this study were 1. to investigate the specified pressure-flow charts obtained when using human blood as the circulating medium and 2. to support extracorporeal membrane oxygenation providers with pressure-flow data for correct choice of the cannula to reach an optimal flow with optimal hydrodynamic performance. Eighteen extracorporeal membrane oxygenation drainage cannulae, donated by the manufacturers (n = 6), were studied in a centrifugal pump driven mock loop. Pressure-flow properties and cannula features were described. The results showed that when blood with a hematocrit of 27% was used, the drainage pressure was consistently higher for a given flow (range 10%-350%) than when water was used (data from each respective manufacturer's product information). It is concluded that the information provided by manufacturers in line with regulatory guidelines does not correspond to clinical performance and therefore may not provide the best guidance for clinicians.

  • 3. Donker, D. W.
    et al.
    Meuwese, C. L.
    Braithwaite, S. A.
    Broomé, Michael
    KTH, School of Technology and Health (STH). Karolinska Institute, Stockholm, Sweden.
    van der Heijden, J. J.
    Hermens, J. A.
    Platenkamp, M.
    de Jong, M.
    Janssen, J. G. D.
    Balík, M.
    Bělohlávek, J.
    Echocardiography in extracorporeal life support: A key player in procedural guidance, tailoring and monitoring2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 1_suppl, p. 31-41Article in journal (Refereed)
    Abstract [en]

    Extracorporeal life support (ECLS) is a mainstay of current practice in severe respiratory, circulatory or cardiac failure refractory to conventional management. The inherent complexity of different ECLS modes and their influence on the native pulmonary and cardiovascular system require patient-specific tailoring to optimize outcome. Echocardiography plays a key role throughout the ECLS care, including patient selection, adequate placement of cannulas, monitoring, weaning and follow-up after decannulation. For this purpose, echocardiographers require specific ECLS-related knowledge and skills, which are outlined here.

  • 4.
    Donker, Dirk W.
    et al.
    Univ Utrecht, Dept Intens Care Med, Univ Med Ctr Utrecht, Utrecht, Netherlands..
    Brodie, Daniel
    Columbia Univ, Coll Phys & Surg, New York Presbyterian Hosp, Div Pulm Allergy & Crit Care Med, New York, NY USA..
    Henriques, Jose P. S.
    Univ Amsterdam, Dept Cardiol, Acad Med Ctr, Amsterdam UMC, Amsterdam, Netherlands..
    Broomé, Michael
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions2019In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, no 2, p. 98-105Article, review/survey (Refereed)
    Abstract [en]

    Short-term mechanical support by veno-arterial extracorporeal membrane oxygenation (VA ECMO) is more and more applied in patients with severe cardiogenic shock. A major shortcoming of VA ECMO is its variable, but inherent increase of left ventricular (LV) mechanical load, which may aggravate pulmonary edema and hamper cardiac recovery. In order to mitigate these negative sequelae of VA ECMO, different adjunct LV unloading interventions have gained a broad interest in recent years. Here, we review the whole spectrum of percutaneous and surgical techniques combined with VA ECMO reported to date.

  • 5. Engström, Gunnar
    et al.
    Appelblad, Micael
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Fat reduction in pericardial suction blood by spontaneous density separation: an experimental model on human liquid fat versus soya oil2003In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 18, no 1, p. 39-45Article in journal (Refereed)
  • 6. Högevold, H. E.
    et al.
    Moen, O.
    Fosse, E.
    Venge, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bråten, J.
    Andersson, C.
    Lyberg, T.
    Effects of heparin coating on the expression of CD11b, CD11c and CD62L by leucocytes in extracorporeal circulation in vitro1997In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 12, no 1, p. 9-20Article in journal (Refereed)
    Abstract [en]

    Leucocyte adhesion molecules are involved in the leucocyte-endothelial interaction and in the activation of coagulation and binding of complement and endotoxin. Thus, they are important in inflammation, systemic acute phase reaction, ischaemia reperfusion injury and resistance against infections. The expression of the adhesion molecules CD11b, CD11c and CD62L on leucocytes and changes in plasma products of neutrophil activation (myeloperoxidase, lactoferrin) and complement activation (C3bc, SC5b-9 (TCC)) were examined in an extracorporeal circulation (ECC) model and the effects of Carmeda bioactive surface (CBAS) heparin coating (n = 7) of the circuits were compared to uncoated control circuits (n = 5). In this model, new 'unactivated' cells mobilized from the bone marrow could not interfere with descriptive measures of cell activation as seen in in vivo studies. In the control group, CD11b and CD11c were upregulated on monocytes and granulocytes during ECC, whereas CD62L was downregulated. Heparin coating reduced the increase in CD11b and CD11c on granulocytes (p < 0.02 at 2 h), but the delayed increase in CD11c on monocytes and the delayed downregulation of CD62L on granulocytes and monocytes did not reach statistical significance. Further, heparin coating also reduced the initial decrease in the absolute cell counts of monocytes and granulocytes (p = 0.01 at 2 h), reflecting reduced adhesion to the oxygenator/tubing. The increases in plasma myeloperoxidase, lactoferrin, C3bc and TCC were lower in the heparin-coated group compared to the control group. The increases in plasma myeloperoxidase and lactoferrin correlated significantly to the increase in CD11b (r = 0.71, p = 0.02 and r = 0.64, p = 0.05, respectively) and CD11c (r = 0.72, p = 0.008 and r = 0.72, p = 0.008, respectively) on granulocytes, suggesting interacting regulatory pathways in the process of neutrophil adhesion, activation and degranulation. Thus, in this in vitro ECC model, heparin coating of oxygenator/tubing sets reduced leucocyte activation and leucocyte adhesion-related phenomena.

  • 7.
    Johagen, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Svenmarker, Staffan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    The scientific evidence of arterial line filtration in cardiopulmonary bypass2016In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 31, no 6, p. 446-457Article in journal (Refereed)
    Abstract [en]

    Background: The indication for arterial line filtration (ALF) is to inhibit embolisation during cardiopulmonary bypass. Filtration methods have developed from depth filters to screen filters and from a stand-alone component to an integral part of the oxygenator. For many years, ALF has been a standard adopted by a majority of cardiac centres worldwide. The following review aims to summarize the available evidence in support for ALF and report on its current practice in Europe. Method: The principles and application of ALF in Europe was investigated using a survey conducted in 2014. The scientific evidence for ALF was examined by performing a systematic literature search in six different databases, using the following search terms: Cardiopulmonary bypass AND filters AND arterial. The primary endpoint was protection against cerebral injury verified by the degree of cerebral embolisation or cognitive tests. The secondary endpoint was improvement of the clinical outcome verified elsewise. Only randomised clinical trials were considered. Results: The response rate was 31% (n=112). The great majority (88.5%) of respondents were using ALF, following more than 10 years of experience. Integrated arterial filtration was used by 55%. Of respondents not using ALF, fifty-four percent considered starting using integrated arterial filtration. The systematic literature database search returned 180 unique publications where 82 were specifically addressing ALF in cardiopulmonary bypass. Only four out of the 82 identified publications fulfilled our inclusion criteria. Of these, three were more than 20 years old and based on the use of bubble oxygenation. Conclusion: ALF is a standard implemented in a majority of cardiopulmonary bypass procedures in Europe. The level of scientific evidence available in support of current arterial line filtration methods in cardiopulmonary bypass is, however, poor. Large, well-designed, randomised trials are warranted.

  • 8.
    Karlsson, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hannuksela, Matias
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Appelblad, Micael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hällgren, Oskar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johagen, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wahba, Alexander
    Svenmarker, Staffan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to minimise transfusions and blood loss2019In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111XArticle in journal (Refereed)
    Abstract [en]

    Background: Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions.

    Methods: In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn <96 hours before surgery were prospectively randomised into two equal sized groups. Cardiopulmonary bypass combined a closed Cortiva (R) heparin-coated circuit with low systemic heparinisation (activated clotting time < 250 seconds) and intraoperative cell salvage in the study group, whereas the control group used a Balance (R) coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments.

    Results: Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 +/- 224 versus 1,100 +/- 989 mL (p < 0.001), reduced packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin -28 +/- 15 versus -40 +/- 14 g/L (p = 0.004) and platelet loss -35 +/- 36 versus -82 +/- 67 x 10(9)/L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate (R) aggregometry, while ROTEM (R) platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences.

    Conclusion: A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.

  • 9. Larsson, M.
    et al.
    Talving, P.
    Palmér, K.
    Frenckner, B.
    Riddez, L.
    Broomé, Michael
    Karolinska Institutet.
    Experimental extracorporeal membrane oxygenation reduces central venous pressure: an adjunct to control of venous hemorrhage?2010In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 25, no 4, p. 217-223Article in journal (Refereed)
    Abstract [en]

    Background: Venoarterial ECMO has been utilized in trauma patients to improve oxygenation, particularly in the setting of pulmonary contusions and ARDS. We hypothesized that venoarterial ECMO could reduce the central venous pressure in the trauma scenario, thus, alleviating major venous hemorrhage. Methods: Ten swine were cannulated for venoarterial ECMO. Central venous pressure, mean arterial pressure, portal vein pressure and portal vein flow were recorded at three different flow rates in both a hemodynamic normal state and a setting of increased central venous pressure and right ventricular load, mimicking acute lung injury. Results: Venoarterial ECMO reduced the central venous pressure (CVP(sup)) from 9.4 +/- 0.8 to 7.3 +/- 0.7 mmHg (p < 0.01) and increased the mean arterial pressure from 103 +/- 8 to 119 +/- 10 mmHg (p < 0.01) in the normal hemodynamic state. In the state of increased right ventricular load, the CVP(sup) declined from 14.3 +/- 0.4 to 11.0 +/- 0.7mmHg (p < 0.01) and the mean arterial pressure (MAP) increased from 66 +/- 6 to 113 +/- 5 mmHg (p < 0.01). Conclusion: Venoarterial ECMO reduces systemic venous pressure while maintaining or improving systemic perfusion in both a normal circulatory state and in the setting of increased right ventricular load associated with acute lung injury. ECMO may be a useful tool in reducing blood loss during major venous hemorrhage in both trauma and selected elective surgery.

  • 10.
    Lindholm, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Heart Centre, Cardiothoracic Surgery, Umeå.
    Engström, Karl-Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Heart Centre, Cardiothoracic Surgery, Umeå.
    Endogenous gas formation of carbon dioxide used for wound flooding: an experimental study with implications regarding gas microembolism during cardiopulmonary bypass2014In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 29, no 3, p. 242-248Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gas microembolisation is an identified risk in cardiac surgery. Flooding the wound with carbon dioxide is a method proposed to reduce this problem. The high solubility of carbon dioxide is beneficial, but may also cause problems. The gas solubility diminishes at warming and endogenous bubbles are formed when cold blood saturated with carbon dioxide is returned by cardiotomy suction.

    METHODS: The release of endogenous gas was measured at high resolution in an experimental digital model. A medium (water or blood) was incubated and equilibrated with gas (100% carbon dioxide or air) at a low temperature (10°C or 23°C). The temperature was increased to 37°C and the gas release was measured, at rest and at fluid motion.

    RESULTS: The amount of carbon dioxide released at warming was substantial for both water and blood (both p=0.005). The effect was more pronounced when the temperature differential increased (p=0.005). However, blood and water differed in these terms: with water, the release of carbon-dioxide started instantly at warming; with blood, carbon dioxide remained dissolved and was released at fluid motion. When blood was warmed from 10°C to 37°C, the gas release corresponded to 44.4% (40.6/46.5) of the medium volume (median with quartile range).

    CONCLUSION: Gas dissolved in a medium becomes released at warming, as confirmed here. Blood exposed to carbon dioxide became heavily oversaturated at warming, with the gas instantly released at fluid motion. The amount of contained gas increased with a higher temperature differential. Our study has relevance to wound flushing, using carbon dioxide, in cardiac surgery. The clinical consequences of these findings remain to be answered.

  • 11.
    Malmqvist, Gunnar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Claesson Lingehall, Helena
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Appelblad, Micael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Svenmarker, Staffan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids2019In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, no 2, p. 130-135Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime.

    METHOD: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Plasma osmolality was analysed on eight occasions. A hyperosmolar CPB prime was used.

    RESULTS: Analyses of the perioperative plasma osmolality on eight occasions gave the following results: the preoperative osmolality level was normal (297±4 mOsm/kg); a significant increase to 322±17 mOsm/kg (p<0.001) was observed at the commencement of CPB and remained elevated after 30 minutes (310±4 mOsm/kg) and throughout the procedure (309±4 mOsm/kg); the osmolality level returned to 291±5 mOsm/kg on day 1 postoperatively and remained normal the following day (291±6 mOsm/kg).

    CONCLUSIONS: Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1.

  • 12. Moen, Oddvar
    et al.
    Fosse, Erik
    Bråten, J.
    Andersson, C.
    Högåsen, Kolbjörn
    Mollnes, Tom Eirik
    Venge, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Kierulf, P.
    Differences in blood activation related to roller/centrifugal pumps and heparin-coated/uncoated surfaces in a cardiopulmonary bypass model circuit1996In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 11, no 2, p. 113-123Article in journal (Refereed)
    Abstract [en]

    An in vitro model cardiopulmonary bypass (CPB) circuit consisting ot tubing, oxygenator and venous reservoirs with either a roller or a centrifugal pump, and with either heparin-coated (Carmeda Bioactive Surface, CBAS) or uncoated surfaces, was studied with respect to 'blood activation', using small-scale-based blood volume (450 + 500 ml). Sixteen circuits were tested in each pump group, eight with and eight without heparin-coated surfaces, by circulating heparinized fresh human blood for 72 hours at 30 degrees C. Blood plasma, sampled at defined intervals, was analysed for haemolysis (lactate dehydrogenase and potassium), complement activation (C3bc and C5b-9 (TCC)), complement lytic inhibitors (vitronectin and clusterin), coagulation activation (fibrinopeptide A), granulocyte (lactoferrin and myeloperoxidase) and platelet (beta-thromboglobulin) activation and contaminating endotoxin. The heparin coating significantly reduced the concentrations of C3bc, TCC, fibrinopeptide A, lactoferrin, myeloperoxidase and beta-thromboglobulin. The two pump types did not differ with respect to these parameters, but the roller pump caused significantly higher increases in plasma LDH and potassium and significantly greater reductions in clusterin and vitronectin than the centrifugal pump. Endotoxin concentration was low at the start and after 24 hours in all groups. These results confirm that heparin-coated CPB surfaces reduce blood activation, and suggest that centrifugal pumps cause less haemolysis and less reduction in lytic complement inhibitors than roller pumps.

  • 13.
    Olsson, A.
    et al.
    Blekinge Institute of Technology, Karlskrona, Sweden; Linköping University, Linköping, Sweden; Blekinge Hospital, Karlskrona, Sweden.
    Alfredsson, J.
    Linköping University, Linköping, Sweden.
    Ramström, Sofia
    Linköping University, Linköping, Sweden.
    Svedjeholm, R.
    Linköping University, Linköping, Sweden.
    Kenny, D.
    Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Håkansson, E.
    Linköping University, Linköping, Sweden.
    Berglund, J. S.
    Blekinge Institute of Technology, Karlskrona, Sweden.
    Berg, S.
    Linköping University, Linköping, Sweden.
    Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer’s chase technique: a randomized pilot study2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    Introduction: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer’s acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques.

    Methods: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer’s chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles).

    Results: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups. Conclusions: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

  • 14.
    Olsson, Anki
    et al.
    Blekinge Inst Technol, Dept Hlth Sci, Vallhallavagen 1, S-37179 Karlskrona, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.;Blekinge Hosp, Dept Cardiothorac Surg, Karlskrona, Sweden..
    Alfredsson, Joakim
    Linkoping Univ, SWE.
    Ramstrom, Sofia
    Linkoping Univ, SWE.
    Svedjeholm, Rolf
    Linkoping Univ, SWE.
    Kenny, Dermot
    Royal Coll Surgeons Ireland, IRE.
    Hakansson, Eric
    Linkoping Univ, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Berg, Soren
    Linkoping Univ, SWE.
    Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique: a randomized pilot study2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    Introduction: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques. Methods: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles). Results: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups. Conclusions: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

  • 15.
    Olsson, Anki
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Health Science, Karlskrona, Blekinge Hospital, Karlskrona, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ramström, Sofia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Kenny, Dermot
    Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Håkansson, Eric
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Berglund, Johan Sanmartin
    Department of Health Science, Karlskrona, Sweden.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique: a randomized pilot study2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques.

    METHODS: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles).

    RESULTS: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups.

    CONCLUSIONS: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

  • 16.
    Seilitz, Jenny
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Vidlund, Mårten
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Norgren, Lars
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jansson, Kjell
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Perioperative intraperitoneal metabolic markers in patients undergoing cardiac surgery with cardiopulmonary bypass: an exploratory pilot study2019In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 34, no 7, p. 552-560Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiopulmonary bypass and postoperative cardiac dysfunction cause splanchnic hypoperfusion resulting in intra-abdominal anaerobic metabolism and risk for gastrointestinal complications. The intra-abdominal metabolism can be monitored by intraperitoneal measurement of relevant metabolites using microdialysis. The aim of this study was to investigate the intraperitoneal metabolism using microdialysis during and after cardiopulmonary bypass at 34°C.

    METHODS: In six patients undergoing elective coronary artery bypass grafting or aortic valve replacement under cardiopulmonary bypass, microdialysis was used to measure intraperitoneal and subcutaneous glucose, lactate, pyruvate, glycerol and glutamate concentrations, intraoperatively and up to 36 hours postoperatively. Arterial and central venous blood gases were analysed as were haemodynamics and the development of complications.

    RESULTS: All patients had an ordinary perioperative course and did not develop gastrointestinal complications. The arterial, intraperitoneal and subcutaneous lactate concentrations changed during the perioperative course with differences between compartments. The highest median (interquartile range) concentration was recorded in the intraperitoneal compartment at 1 hour after the end of cardiopulmonary bypass (2.1 (1.9-2.5) mM compared to 1.3 (1.2-1.7) mM and 1.5 (1.0-2.2) mM in the arterial and subcutaneous compartments, respectively). In parallel with the peak increase in lactate concentration, the intraperitoneal lactate/pyruvate ratio was elevated to 33.4 (12.9-54.1).

    CONCLUSION: In cardiac surgery, intraperitoneal microdialysis detected changes in the abdominal metabolic state, which were more pronounced than could be shown by arterial blood gas analysis. Despite an uneventful perioperative course, patients undergoing low-risk surgery under cardiopulmonary bypass might be subjected to a limited and subclinical intra-abdominal anaerobic state.

  • 17. Svenmarker, S.
    et al.
    Engström, K.G.
    Karlsson, Thomas
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Cognition, Development and Disability.
    Jansson, E.
    Lindholm, R.
    Åberg, T.
    Influence of pericardial suction blood retransfusion on memory function and release of protein S100B2004In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 19, no 6, p. 337-343Article in journal (Refereed)
    Abstract [en]

    Background: To study the influence of pericardial suction blood (PSB) on postoperative memory disturbances and release patterns of protein S100B during and after cardiopulmonary bypass (CPB). Methods: Sixty male patients admitted for coronary artery bypass surgery were prospectively randomized to receive PSB either by using conventional cardiotomy suction retransfusion or after cell-saver processing. Results: The concentration of S100B rose during the period of CPB from 0.065 ± 0.004 to 0.24 ± 0.001 μg/L (p <0.001). PSB contained 18.0 ± 1.7 μg/L of S100B. Direct retransfusion from the cardiotomy reservoir made the systemic level increase to 1.42 ± 0.19 μg/L compared to 0.25±0.02 μg/L using a cell-saver. Signs of postoperative memory dysfunction (>1 SD) were discovered in one of three tests, but were unrelated to technique of retransfusion. No associations were found between serum concentrations of S100B and memory function. Conclusion: In this study, retransfusion of PSB during cardiac surgery appeared not to cause memory disturbances. PSB contained high concentrations of protein S100B making its use as a marker of cerebral injury unsuitable. © Arnold 2004.

  • 18.
    Svenmarker, Staffan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Hannuksela, Matias
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 6, p. 453-462Article in journal (Refereed)
    Abstract [en]

    Objectives: The patient's body surface area serves as the traditional reference for the determination of systemic blood flow during cardiopulmonary bypass (CPB). New strategies refer to different algorithms of oxygen delivery. This study reports on the mixed venous oxygen saturation (SvO2) as the target for systemic blood flow control. We hypothesise that an SvO2>75% (S(v)O(2)75) is associated with better preservation of renal function and improved short-term survival.

    Methods: This retrospective, 10-year, observational study analysed 6945 consecutive cardiac surgical cases requiring CPB. Endpoints included rates of acute kidney injury (AKI) and short-term survival, also the estimated glomerular filtration rate ((e)GFR), lactate levels and blood transfusions.

    Results: Seventy-seven percent of the patients attained the S(v)O(2)75 target. For this group, the median SvO2 was 78.1 (5.8) %, with a mean oxygen delivery of 331 (78) ml/min per m(2) body surface area. Overall incidence of AKI levels (I-III): 7.5% - 2.6% - 0.6%. Incidence of (e)GFR (<50%): 3.9%, increasing to 6% for haemoglobin levels <80 g/L (p<0.001). Red cell transfusion was more frequent (p<0.001) within this group (30.6%) compared to levels >100 g/L (0.3%). Further, women (52.8%) were transfused more often than men (14.6%). Lactate level at weaning from CPB was 1.3 (0.7) mmol/L. The S(v)O(2)75 target demonstrated a relative risk reduction of 22.5% (p=0.032) for AKI (I), increasing to 32.3% (p=0.026) for procedures extending >90 minutes. In addition, the risk for death 90-days postop was lower (p=0.039).

    Conclusion: The S(v)O(2)75 target showed a decreased risk for postoperative AKI and prolonged short-term survival. Good clinical outcomes were also linked to measures of lactate and the (e)GFR. However, anaemia remains a risk factor for AKI.

  • 19. Thomassen, S. A.
    et al.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Andreasen, J. J.
    Bundgaard, W.
    Boegsted, M.
    Rasmussen, B. S.
    Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?2011In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 26, no 1, p. 45-50Article in journal (Refereed)
    Abstract [en]

    Blood flow during cardiopulmonary bypass (CPB) is calculated on body surface area (BSA). Increasing comorbidity, age and weight of today's cardiac patients question this calculation as it may not reflect individual metabolic requirement. The hypothesis was that a measured cardiac index (CI) prior to normothermic CPB is a better estimate. A cross-over study, with random allocation to CPB blood flow for 20 minutes based on either a calculation (2.4 L/min/m(2)) or on CI, with a switch to the opposite flow for another 20 minutes, was performed. Twenty-two elective cardiac surgery patients with normal ventricular function were included. Effect parameters were cerebral oxygenation, mixed venous saturation and arterial lactate. CI varied from 1.9 to 3.1 L/min/m(2) (median 2.4 L/min/m(2)). No differences in effect parameters were seen. In conclusion, a CPB blood flow based on an individual estimate did not improve cerebral and systemic oxygenation compared to a blood flow based on BSA.

  • 20.
    Thomassen, Sisse Anette
    et al.
    Aalborg Univ Hosp, Dept Anaesthesiol & Intens Care Med, Hobrovej 18-22, DK-9100 Aalborg, Denmark;Aalborg Univ, Dept Clin Med, Aalborg, Denmark.
    Kjaergaard, Benedict
    Aalborg Univ, Dept Clin Med, Aalborg, Denmark;Aalborg Univ Hosp, Dept Cardiothorac Surg, Aalborg, Denmark.
    Alstrup, Aage Kristian Olsen
    Aarhus Univ Hosp, Dept Nucl Med, Aalborg, Denmark;Aarhus Univ Hosp, PET Ctr, Aalborg, Denmark.
    Munk, Ole Lajord
    Aarhus Univ Hosp, Dept Nucl Med, Aalborg, Denmark;Aarhus Univ Hosp, PET Ctr, Aalborg, Denmark.
    Frokiaer, Jorgen
    Aarhus Univ Hosp, Dept Nucl Med, Aalborg, Denmark;Aarhus Univ Hosp, PET Ctr, Aalborg, Denmark.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rasmussen, Bodil Steen
    Aalborg Univ Hosp, Dept Anaesthesiol & Intens Care Med, Hobrovej 18-22, DK-9100 Aalborg, Denmark;Aalborg Univ, Dept Clin Med, Aalborg, Denmark.
    Cerebral blood flow measured by positron emission tomography during normothermic cardiopulmonary bypass: an experimental porcine study2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 5, p. 346-353Article in journal (Refereed)
    Abstract [en]

    Background: Mean arterial blood pressure (MAP) and/or pump flow during normothermic cardiopulmonary bypass (CPB) are the most important factors of cerebral perfusion. The aim of this study was to explore the influence of CPB blood flow on cerebral blood flow (CBF) measured by dynamic positron emission tomography (PET) using O-15-labelled water with no pharmacological interventions to maintain the MAP.

    Methods: Eight pigs (69-71 kg) were connected to normothermic CPB. After 60 minutes (min) with a CPB pump flow of 60 mL/kg/min, the pigs were changed to either 35 mL/kg/min or 47.5 mL/kg/min for 60 min and, thereafter, all the pigs returned to 60 mL/kg/min for another 60 min. The MAP was measured continuously and the CBF was measured by positron emission tomography (PET) during spontaneous circulation and at each CPB pump flow after 30 min of steady state.

    Results: Two pigs were excluded due to complications. CBF increased from spontaneous circulation to a CPB pump flow of 60 mL/kg/min. A reduction in CPB pump flow to 47.5 mL/kg/min (n=3) resulted in only minor changes in CBF while a reduction to 35 mL/kg/min (n=3) caused a pronounced change (correlation coefficient (R-2) 0.56). A return of CPB pump flow to 60 mL/kg/min was followed by an increase in CBF, except in the one pig with the lowest CBF during low flow (R-2=0.44). CBF and MAP were not correlated (R-2=0.20).

    Conclusion: In this experimental porcine study, a relationship was observed between pump flow and CBF under normothermic low-flow CPB. The effect of low pump flow on MAP showed substantial variations, with no correlation between CBF and MAP.

  • 21.
    Thomassen, Sisse Anette
    et al.
    Aalborg Univ Hosp, Dept Anaesthesiol & Intens Care Med, Hobrovej 18-22, DK-9100 Aalborg, Denmark.;Aalborg Univ, Dept Clin Med, Aalborg, Denmark..
    Kjaergaard, Benedict
    Aalborg Univ, Dept Clin Med, Aalborg, Denmark.;Aalborg Univ Hosp, Dept Cardiothorac Surg, Aalborg, Denmark..
    Sorensen, Preben
    Aalborg Univ, Dept Clin Med, Aalborg, Denmark.;Aalborg Univ Hosp, Dept Neurosurg, Aalborg, Denmark..
    Andreasen, Jan Jesper
    Aalborg Univ, Dept Clin Med, Aalborg, Denmark.;Aalborg Univ Hosp, Dept Cardiothorac Surg, Aalborg, Denmark..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rasmussen, Bodil Steen
    Aalborg Univ Hosp, Dept Anaesthesiol & Intens Care Med, Hobrovej 18-22, DK-9100 Aalborg, Denmark.;Aalborg Univ, Dept Clin Med, Aalborg, Denmark..
    Regional muscle tissue saturation is an indicator of global inadequate circulation during cardiopulmonary bypass: a randomized porcine study using muscle, intestinal and brain tissue metabolomics2017In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 32, no 3, p. 192-199Article in journal (Refereed)
    Abstract [en]

    Background: Muscle tissue saturation (StO(2)) measured with near-infrared spectroscopy has generally been considered a measurement of the tissue microcirculatory condition. However, we hypothesized that StO2 could be more regarded as a fast and reliable measure of global than of regional circulatory adequacy and tested this with muscle, intestinal and brain metabolomics at normal and two levels of low cardiopulmonary bypass blood flow rates in a porcine model. Methods: Twelve 80 kg pigs were connected to normothermic cardiopulmonary bypass with a blood flow of 60 mL/kg/min for one hour, reduced randomly to 47.5 mL/kg/min (Group I) or 35 mL/kg/min (Group II) for one hour followed by one hour of 60 mL/kg/min in both groups. Regional StO(2) was measured continuously above the musculus gracilis (non-cannulated leg). Metabolomics were obtained by brain tissue oxygen monitoring system (Licox) measurements of the brain and microdialysis perfusate from the muscle, intestinal mucosa and brain. A non-parametric statistical method was used. Results: The systemic parameters showed profound systemic ischaemia during low CPB blood flow. StO(2) did not change markedly in Group I, but in Group II, StO(2) decreased immediately when blood flow was reduced and, furthermore, was not restored despite blood flow being normalized. Changes in the metabolomics from the muscle, colon and brain followed the changes in StO(2). Conclusion: We found, in this experimental cardiopulmonary bypass model, that StO(2) reacted rapidly when the systemic circulation became inadequate and, furthermore, reliably indicate insufficient global tissue perfusion even when the systemic circulation was restored after a period of systemic hypoperfusion.

  • 22.
    Tovedal, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Lennmyr, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis.2016In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 31, no 1, p. 72-77Article in journal (Refereed)
    Abstract [en]

    Pulsatile and non-pulsatile cardiopulmonary bypass (CPB) flows may have different impact on cerebral oxygen saturation in patients with restricted cerebral arterial blood supply. Twenty patients, ten diagnosed with carotid stenosis (CS, n = 10) and ten without known carotid disease (Controls, n = 10), were subjected to one period of pulsatile and one period of non-pulsatile flow (6-8 min each) during CPB at 32°C. Cerebral oxygen saturation was registered by near-infrared light spectroscopy (NIRS). The mean arterial pressure (MAP) was significantly lowered by pulsatile CPB flow. The NIRS tissue oxygenation index (TOI) tended to decrease in the CS group and increase in the Controls during pulsatile flow compared with non-pulsatile; however, the changes were not statistically significant. No significant correlations were seen between the changes in MAP and TOI across the observation periods. In conclusion, pulsatile CPB flow caused slightly decreased mean arterial pressure while the effect on cerebral oxygenation was unclear. Pulsatile flow was not found superior to non-pulsatile flow in patients with or without carotid stenosis.

  • 23.
    Tovedal, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Lennmyr, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis2015In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111XArticle in journal (Refereed)
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