Perfline |  |
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The search for a small CPB circuit for use in neonates continues. Charette and coworkers reported on a 180 ml capacity system that has offered excellent results. Starting on 1999, the authors began using a circuit which could be primed with 172 ml. This allowed a decrease in intraoperative hemodilution and a higher perioperative hematocrit. Their circuit was used for patients less than 5.1 kg. The authors used a 1/4" tubing for the arterial roller (0.82 ml/inch), 3/16" tubing (0.45 ml/inch) for the venous line, and 1/8" (0.20 ml/inch) tubing for the arterial line. No arterial filter was interposed in the circuits to maintain the lowest possible prime volume. The authors obtained a decreased use of exogenous blood, less contact activation, less intense intraoperative inflammation, and reduced costs. By replacing a few components the prime could be further reduced to 122 ml.
Now it is possible to use a circuit with a less than 1:1 ratio between the neonate´s blood volume (about 250 ml) and priming volume.
Ref. Charette K et cols. Perfusion 2007;22;327.
March 12, 2008 11:10 am - Rio de Janeiro, Brazil |
James Garner | |
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Cardiopulmonary bypass (CPB) with hemodilution in neonates and infants induces an increase in capillary permeability, resulting in accumulation of extravascular fluid and organ dysfunction. All efforts at reducing the size of CPB circuits should be commended. Small circuits (and devices) will reduce the size of nonendothelial surfaces, and as a consequence, the intensity of the systemic inflammatory reaction. Results of cardiac suregery in neonates have improved with the adoption of small prime circuits, and will hopefully continue to improve, as new and improved devices and circuit designs are brought to our practice. It has been demonstrated that with a smaller priming volume, the water balance value after CPB and surgery is significantly lower, systolic blood pressure after CPB is higher, and postoperative ventilatory support is shorter. In neonatal cardiac surgery, low-priming-volume CPB circuits improve the water balance during surgery and may attenuate any inflammatory reaction, which would help to preserve postoperative organ function.
March 27, 2008 10:21 am - Stockholm, Sweden |
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