Postoperative Morbidity Following Red Cell Deformability Changes During Cardiopulmonary Bypass Using Bubble and Membrane Oxygenators

Abstract

The preoperative blood cell trauma and postoperative morbidity were com pared in a prospective randomized study in two groups of patients undergoing cardiac surgery with extracorporeal circulation (ECC). One group was oxygen ated during ECC with a membrane oxygenator (MO) and the other with a bub ble oxygenator (BO). Red cell trauma was ascertained by a standard microfiltration technique that expressed the rheologic properties of standard ized red cell suspensions.

The filtrability of the cell suspension was significantly reduced during ECC for both membrane (MO) and bubble (BO) oxygenators. However, the bubble type proved to be more traumatic, and the difference was statistically signifi cant after thirty minutes of ECC. The filtrability was reduced by 20% in the MO group and by 35% in the BO group at the end of ECC (p < 0.01).

A significantly higher frequency of postoperative bleeding (p < 0.05), blood transfusion (p < 0.05), and arrhythmias was found in the BO group (p < 0.01).

This study demonstrates that the microrheology of red blood cells is better preserved with the membrane oxygenator, which is associated with a smoother postoperative course, owing probably to a better preserved microcirculation. The membrane oxygenator can be recommended even for short perfusions and routine procedures requiring cardiopulmonary bypass (CPB) and should be used whenever possible.

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References

Hill DJ , Gerbode F. : Prolonged extracorporeal circulation. In: Gibbons, Surgery of the Chest, ed. by Sabiston D , Spencer F. Philadelphia, WB Saunders, 1976, pp 867-877.

Schmid-Schönbein H. : Biological analysis of blood trauma: The reponses of the unspecific defense system to foreign technical apparatus. In: Basic Aspects of Blood Trauma, ed. by Schmid-Schönbein H , Teitel P. The Hague, Martinus Nijhoff Publisher, 1979, pp 1-22.

Hirayama T. , Yamaguchi H. , Allers M. , et al: Change in red cell deformability associated with anesthesia and cardiopulmonary bypass in open-heart surgery. Scand J Thorac Cardiovasc Surg 19:257-262, 1985.

Hirayama T. , Roberts D. , Allers M. , et al: Association between arrhythmias and reduced red cell deformability following cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg (accepted for publication Aug. 9, 1987, in press)

Hirayama T. , Roberts D. , Allers M. , et al: Association between bleeding and reduced red cell deformability following cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg (accepted for publication Aug. 9, 1987, in press)

Hirayama T. , Roberts D. , Allers M. , et al: Association between pulmonary dysfunction and reduced red cell deformability following cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg (accepted for publication Aug. 9, 1987, in press)

Swinscow Tdv : Statistics at Square One. London, British Medical Association, 1976, pp 28-53.

Van den Dungen Jjam , Karlinczek GF , Brenken U. , et al: Clinical study of blood trauma during perfusion with membrane and bubble oxygenators. J Thorac Cardiovasc Surg 83:108-116, 1982.

Clark RE , Beauchamp RA , Magrath RA , et al: Comparison of bubble and membrane oxygenators in short and long perfusions. J Thorac Cardiovasc Surg 78:655-666, 1979.

10.

Van Oeveren W , Kazatchkine MD , Descamps-Latscha B. , et al: Deleterious effects of cardiopulmonary bypass: A prospective study of bubble versus membrane oxygenators . J Thorac Cardiovasc Surg 89:888-899, 1985.

11.

Santiago-Delpin EA , Mobeg AW , Mozes MF , et al: Comparative analysis of perfusion and non-perfusion methods for renal preservation. Surgery 72:793-803, 1972.

12.

Birnbaum D. , Soyer T. , Eiseman B. : Studies in prolonged liver preservation. Surgery 72:722-729, 1972.

13.

Hill JD , O'Brien TG , Murray JJ , et al: Prolonged extracorporeal oxygenation for acute posttraumatic respiratory failure (short-lung syndrome). Use of the Bramson membrane lung . N Engl J Med 286:629-634, 1972.

14.

Pois AJ , Katzman L. , Weston CB , et al: Long term support with membrane lung. Chest 62:690-693, 1972.

15.

Fallat RJ , Hill DJ , Eberhart EC , et al: Treatment of acute respiratory failure with prolonged extracorporeal oxygenation. Chest 66:38S-40S, 1974.

16.

Pyle RB , Helton WC , Johnson FW , et al: Clinical use of the membrane oxygenator. Arch Surg 110:966-970, 1975.

17.

Gellhoed GW , Adkins PC , Corso PJ , et al: Clinical effects of membrane lung support for acute respiratory failure. Ann Thorac Surg 20:177-187, 1975.

18.

Bartlett RH , Gazzaniga AB , Fong SW , et al: Extracorporeal membrane oxygenator support for cardiopulmonary failure. J Thorac Cardiovasc Surg 73:375-386, 1977.

19.

Massimino RJ : Membrane versus bubble. JECT 15:156-158, 1983.

20.

Bull HB , Neurath H. : The denaturation and hydration of proteins: II. Surface denaturation of egg albumin. J Biol Chem 118:163-168, 1937.

21.

Neurath H. , Greenstein JP , Putnam FW , et al: The chemistry of protein denaturation. Chem Rev 34:157-162, 1944.

22.

Stoney WS , Alford WC Jr , Burrus GR , et al: Air embolism and other accidents using pump oxygenators. Ann Thorac Surg 29:336-340, 1980.

23.

Boers M. , van den Dungen Jjam , Karliczek GF , et al: Two membrane oxygenators and a bubble. A clinical comparison . Ann Thorac Surg 35:455-462, 1983.

24.

Peirce EC II: Is the blood-gas interface of clinical importance ? Ann Thorac Surg 17:526-529, 1974.

25.

De Jong Jcf , Wildevuur Crh : Cardiopulmonary bypass: Analysis of various components of the circuit in canine experiments. In: Proceedings of the 3rd Annual Symposium of the Red Cross Blood Bank, Groningen-Drenthe, "Open Heart Surgery and Blood Transfusions ," Oct 1987.

26.

Hirayama T. , Roberts D. , William-Olsson G. : Mechanical trauma to red blood cells caused by Björk-Shiley and Carpentier-Edwards heart valves . Scand J Thorac Cardiovasc Surg 19:253-256, 1985.