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Ultrafiltration and pediatric cardiopulmonary bypass

Published online by Cambridge University Press:  19 August 2008

Surendra K. Naik  and
Martin J. Elliott
Surendra K. Naik
Affiliation:
From the Department of Cardiac Surgery, Glasgow Royal Infirmary, Glasgow
Martin J. Elliott*
Affiliation:
From the Department of Cardiac Surgery, The Hospital For Sick Children, London
*
Mr. Martin J. Elliott, Cardiothoracic Unit, The Hospital For Sick Children, Great Ormond Street, London WCIN 3JH, United Kingdom.
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Extract

The technique of modified ultrafiltration is a more efficient application of the concept of ultrafiltration during cardiopulmonary bypass. It has been shown to be superior to the conventional method of ultrafiltration.

The method can save considerable quantities of donor blood by returning not only the red cells, but also the white cells, platelets, and clotting factors back to the patient, components which otherwise would be discarded. The elevation of the hematocrit made possible by this method after bypass will permit an “acceptable” hematocrit to be achieved when temperatures become normal after ultrafiltration. The return of platelets and clotting factors along with a high hematocrit will contribute towards significantly minimizing the postoperative loss of blood, and, consequently, the amount of blood requiring to be transfused. The possibility of elevation of the hematocrit allows for a lower hematocrit during bypass. This can achieve a considerable saving of donor blood, particularly in small children who invariably need blood added to the prime, making bloodless pediatric surgery a real possibility. The technique also minimizes the rise in total water in the body after cardiopulmonary bypass in children and promises favorably to alter the course of leaking capillaries as seen frequently in neonates and infants. It has been shown to improve hemodynamics at a crucial time when the patient has been weaned from cardiopulmonary bypass and needs optimum conditions for recovery. From the point of view of research, ultrafiltration offers a window to look at the inflammatory process induced by cardiopulmonary bypass.

It promises to be a valuable technique to investigate the elimination and possibly quantification of toxic metabolites produced during bypass. It also allows evaluation and assessment of different protocols for bypass, involving varying rates of flow and temperature, for their response to the production of these toxic metabolites, thus offering the potential to achieve a model of cardiopulmonary bypass which is as physiological as possible. With advances in the systems of perfusion, aided by computers, it should be possible to control the rate of ultrafiltration and precisely regulate the transfusion of the venous reservoir fluid with the aid of feedback loops from the venous and arterial pressures in the heart. This could make ultrafiltration an integral part of routine cardiopulmonary bypass.

Keywords

Primefluid compartmentbypass circuitsmodified ultrafiltration
Type
World Forum for Pediatric Cardiology Symposium on Cardiopulmonary Bypass (Part 2)
Information
Cardiology in the Young , Volume 3 , Issue 4 , October 1993 , pp. 331 - 339
Copyright
Copyright © Cambridge University Press 1993

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References

1.Kirklin, JK, Blackstone, EH, Kirklin, JW. Cardiopulmonary bypass: Studies on its damaging effects. Blood Purification 1987; 5: 168–178.CrossRefGoogle ScholarPubMed
2.Brans, YW, Dweck, HS, Havis, HB, Park, GVS, Bailey, PE, Kirklin, JW, Cassady, G. Effects of open heart surgery on the body composition of infants and young children. Pediatr Res 1981; 15: 1024–1028.CrossRefGoogle ScholarPubMed
3.Pacifico, AD, Digerness, S, Kirklin, JW. Acute alterations in body composition after open intracardiac operations. Circulation 1970; 41: 331–341.CrossRefGoogle ScholarPubMed
4.Asada, S, Yamaguchi, M.. Fine structural change in the lung following cardiopulmonary bypass. It's relationship to early postoperative course. Chest 1971; 59: 478–483.CrossRefGoogle Scholar
5.Staub, NC. Pulmonary edema. Physiological approaches to management. Chest 1978; 74: 559–566.CrossRefGoogle ScholarPubMed
6.Kopman, EA, Ferguson, TB. Pulmonary edema following cardiopulmonary bypass. Anaesth Analg 1978; 57: 367–370.CrossRefGoogle ScholarPubMed
7.Laks, H, Standeven, J, Blair, O, Hahn, J, Jellinek, M, Willman, VL. The effects of cardiopulmonary bypass with crystalloid and colloid haemodilution on myocardial extravascular water. J Thorac Cardiovasc Surg 1977; 73: 129–134.CrossRefGoogle ScholarPubMed
8.Rigden, SPA, Barratt, TM, Dillon, MJ, de Leval, M, Stark, J.. Acute renal failure complicating cardiopulmonary bypass surgery. Arch Dis Child 1982; 57: 425–430.CrossRefGoogle ScholarPubMed
9.Maehara, T, Novak, I, Elliott, MJ. Perioperative monitoring of total bodywater by bioelectrical impedance in children under going open heart surgery. Euro J Cardiothorac Surg 1991; 5: 258–265.CrossRefGoogle Scholar
10.Novak, I, Davies, PSW, Elliott, MJ. Non invasive estimation of total body water in critically ill children after cardiac opera tions. J Thorac Cardiovasc Surg 1992; 104: 585–589.CrossRefGoogle Scholar
11.Elliott, MJ. Perfusion for paediatric open heart surgery. Sem Thorac Cardiovasc Surg 1990; 2: 332–340.Google Scholar
12.Roe, BR, Swenson, EE, Hepps, SA, Burns, DL. Total body perfusions in cardiac operations with perfusate of balanced electrolytes and low molecular weight dextran. Arch Surg 1964; 88: 128–134.CrossRefGoogle ScholarPubMed
13.Hepps, SA, Roe, BR, Wright, RR, Gardner, RE. Amelioration of the postperfusion syndrome with hemodilution and low mo lecular weight dextran. Surgery 1963; 54: 32–43.Google Scholar
14.Utley, JR, Wachtel, C, Cain, RB, Spaw, EA, Collins, JC, Stephens, DB. Effects of hypothermia, hemodilution and pump oxygenation on organ water content, blood flow and oxygen delivery and renal function. Ann Thorac Surg 1981; 31: 121–133.CrossRefGoogle ScholarPubMed
15.Ratcliffe, JM, Elliott, MJ, Wyse, RKH. The metabolic load of stored blood. Implications for major transfusions in infants. Arch Dis Child 1986; 61: 1208–1214.CrossRefGoogle ScholarPubMed
16.Kawaguchi, A, Bergsland, J, Subramanian, S. Total bloodless open heart surgery in the paedidatric age group. Circulation 1984; 70(Suppl I): I30–I37.Google Scholar
17.Layer, MB, Buckley, MJ. Extreme hemodilution in the surgical patient. In: Messmer, K, Schmid-Schonbein, H (eds). Hemodi lution. Theoretical Basis and Clinical Application. Karger, Basel, 1985, p. 215.Google Scholar
18.Hoeft, A, Korb, H, Melhorn, U, Stephan, H, Sonntag, H. Priming of cardiopulmonary bypass with human albumin or Ringer lactate: Effect on colloidal osmotic pressure and travascular lung water. Br J Anaes 1991; 66: 73–80.CrossRefGoogle ScholarPubMed
19.Bjornson, J. Thrombus formation in the artificial kidney. Scand J Urol Nephrol 1978; 12: 251–257.CrossRefGoogle ScholarPubMed
20.Horl, W, Schafer, RM, Heidland, A. Effects of different dialyzers on proteinases and proteinase inhibitors during hemodialysis. Am J Nephrol 1985; 5: 320–326.Google ScholarPubMed
21.Cheung, A, Henderson, L. Effects of complement activation by hemodialysis membranes. Am J Nephrol 1986; 6: 81–91.CrossRefGoogle ScholarPubMed
22.Wegmuller, E, Descoeudres, C, Hodler, J. Biocompatibility of hemodialysis membranes: Activation of complement and leu kopenia. Kidney Tnt 1985; 28: 361–363.Google Scholar
23.Ringoir, S, Vanholder, R. An introduction to biocompatibility. Artf Organs 1986; 10: 20–27.CrossRefGoogle ScholarPubMed
24.Magilligan, DJ. Indications for ultrafiltration in the cardiac surgical patient. J Thorac Cardiovasc Surg 1985; 89: 183–189.CrossRefGoogle ScholarPubMed
25.Morgan, SH, Mansell, MA, Thomson, FD. Fluid removal by haemoflltration in diuretic resistant cardiac failure. Br Heart J 1985; 54: 218–219.CrossRefGoogle Scholar
26.Bodt, J, Kling, D, Bormann, BV, Scheed, HH, Hemplemann, G. Extravascular lung water and hemofiltration during complicated cardiac surgery. Thorac Cardiovasc Surgeon 1987; 35: 161–165.CrossRefGoogle Scholar
27.Walpoth, B, Geroulanos, S, Egloff, L, Turina, M, Senning, A. Reduction of post bypass hemodilution by hemofiltration. Eur Soc Art Organs 1979; 6:315–321.Google Scholar
28.Vertrees, RA, Auvil, J, Harding, E, Sweet, S, Rousou, JH, Engleman, RM. A technique of hemoconcentration. J Extra-corporeal Tech 1982; 14: 431–444.Google Scholar
29.Holt, DW, Landis, GH, Dumond, DA, Hardin, SB, Miller, M. Hemofiltration as an adjunct to cardiopulmonary bypass for total oxygenator volume control. J Extracorporeal Tech 1982; 14: 373–378.CrossRefGoogle Scholar
30.Klinberg, PL, Kam, CA, Johnson, DC, Cartmill, TB, Brown, JH. Hematocrit and blood volume control during cardiopulmo nary bypass with the use of hemofiltration. Anaesthesiology 1984; 60: 478–480.CrossRefGoogle Scholar
31.Magilligan, DJ, Oyama, C. Ultrafiltration during cardiopulmonary bypass: Laboratory evaluation and initial clinical experience. Ann Thorac Surg 1984; 37: 33–39.CrossRefGoogle ScholarPubMed
32.Nakamura, Y, Masuda, M, Toshima, Y, Asou, T, Oe, M, Kinoshita, K, Kawachi, Y, Tanaka, J, Tokunaga, K. Comparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery. Ann Thrac Surg 1990; 49: 973–978.CrossRefGoogle ScholarPubMed
33.Coraim, FJ, Coraim, HP, Ebermann, R, Steliwag, FM. Acute respiratory failure after cardiac surgery: Clinical experience with the application of continuous arteriovenous hemofil tration. Crit Care Med 1986; 14: 714–718.CrossRefGoogle Scholar
34.Naik, SK, Knight, A, Elliott, MJ. A successful modification of ultrafiltration for cardiopulmonary bypass in children. Perfusion. 1991; 6:41–50.CrossRefGoogle ScholarPubMed
35.Naik, SK, Knight, A, Elliott, MJ. A prospective randomized study of a modified technique of ultrafiltration during paediatric open heart surgery. Circulation. 1991; 84 (suppl III): III 422–III 431.Google Scholar
36.Falkenhagen, D, Zinner, G, Falkenhagen, U, Ahrenholtz, P, Holtz, M, Behm, E, Klinkmann, H. A modified cellulose membrane (Mc) with reduced complement activation. Kid ney Tnt 1985; 28: 331.Google Scholar
37.Shin, J, Matsuo, M, Shinko, S, Fujita, Y, Tnoue, S, Sakai, R, Nishioka, M. A study on hemodialysis leukopenia using vari ous dialyzers. J Dial 1980; 4: 151–162.Google Scholar
38.Henderson, LW, Cheung, AK, Chenoweth, DE. Choosing a membrane. Amer J Kiidney Dis 1983; 4: 15–20.Google Scholar