Eugene Smith |  |
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Prime volume and surface area available for blood contact are two major considerations in modern cardiopulmonary bypass (CPB).
Lower priming volumes and small circuits have gained the race against older standards because their combination allows a lower incidence of transfusion of blood products and minimizes the inflammatory systemic body reaction to CPB.
We should not, however, forget perfusion time. Even when using a small foreign surface circuit, perfusion time will be another variable involved in the production and the intensity of the systemic inflammatory reaction. The protein and cellular systems involved in the production of the inflammatory reaction are stimulated and activated very soon after starting CPB. In my judgement one or two hours of CPB should have the same effect on the inflammatory mediators, regardless the surface area to which blood is exposed.
April 21, 2008 10:24 am - New Zeland |
Perfline | |
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Time on pump is a major consideration in the production and intensity of the systemic inflammatory reaction. One and a half hour of cardiopulmonary bypass performed with a regular or a minimized circuit, will expose blood to a foreign surface equaly.
Moving to a smaller circuit will reduce the degree of hemodilution and this may play a pivotal role in minimizing the consequences of CPB rather than simply having less nonendothelial surfaces available for contact. April 26, 2008 10:02 am - Rio de Janeiro, Brazil |
Jennyfer Sintell | |
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Low prime volume pump used as a closed circuit has been demonstrated as less excitation of coagulation system and a reduction on the intensity of the systemic inflammatory reaction. Measures of thrmobin-antithrombin III complexex, complement factorm and interleukin-10 were all significantly lower than controls using normal prime volume and conventional CPB circuit. Low prime does not only contribute to the reduction of blood products use; it also decreases the intensity of inflammatory response, at least under the biochemical view. June 2, 2008 10:52 am - New Zeland |
Rajeev Gupta | |
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You are correct sir in A.I.I.M.S, DELHI our experience with multi modality approach is almost same(mini circuit, autologus priming ,coated circuits and use of fibrinolytics all the way usefull and yeild clinically significant results in blood conservation and better pt.outcome postoperatively.however bypass time greater then two hours means more blood loss and increses risk of morbidity and mortality. May 28, 2009 11:40 am - INDIA DELHIi |
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BLIND RIVET NUT July 28, 2010 08:23 am |
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