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Cpb gme

Carl J Gisnarian, Angela Hedman, Kenneth G Shann
Gaseous microemboli (GME) are a potential complication of cardiopulmonary bypass (CPB). Though it is difficult to prove that GME is the only major cause of neurological deficits, it may increase the chance of post-operative cognitive dysfunction if not removed. The objectives of this research were to compare LivaNova-Sorin Inspire (Inspire) oxygenator with a Medtronic arterial filter to the Medtronic Fusion (Fusion) oxygenator with and without a Medtronic arterial filter based on each system's ability to handle GME...
December 2017: Journal of Extra-corporeal Technology
Tim Segers, Marco C Stehouwer, Filip M J J de Somer, Bastian A de Mol, Michel Versluis
INTRODUCTION: Gaseous microemboli (GME) introduced during cardiac surgery are considered as a potential source of morbidity, which has driven the development of the first bubble counters. Two new generation bubble counters, introduced in the early 2000s, claim correct sizing and counting of GME. This in-vitro study aims to validate the accuracy of two bubble counters using monodisperse bubbles in a highly controlled setting at low GME concentrations. METHODS: Monodisperse GME with a radius of 43 µm were produced in a microfluidic chip...
January 2018: Perfusion
Shigang Wang, Luiz F Caneo, Marcelo B Jatene, Fábio B Jatene, Idagene A Cestari, Allen R Kunselman, Akif Ündar
The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr arterial cannula, primed with lactated Ringer's solution and packed red blood cells...
June 8, 2017: Artificial Organs
Shigang Wang, Allen R Kunselman, Akif Ündar
The Capiox RX25 and Quadrox-i Adult oxygenators are commonly used in clinical adult cardiopulmonary bypass circuits. This study was designed to test the effectiveness of two adult oxygenators in order to evaluate gaseous microemboli (GME) trapping capability and hemodynamic performance. A simulated adult CPB circuit was used and primed with Ringer's lactate and packed red blood cells (hematocrit 25%). All trials were conducted at flow rates of 2-5 L/min (1 L/min increments) with a closed and open arterial filter purge line at 35°C...
May 2016: Artificial Organs
Gregory S Matte, Kevin R Connor, Hua Liu, James A DiNardo, David Faraoni, Frank Pigula
Gaseous microemboli (GME) are known to be delivered to the arterial circulation of patients during cardiopulmonary bypass (CPB). An increased number of GME delivered during adult CPB has been associated with brain injury and postoperative cognitive dysfunction. The GME load in children exposed to CPB and its consequences are not well characterized. We sought to establish a baseline of arterial limb emboli counts during the conduct of CPB for our population of patients requiring surgery for congenital heart disease...
March 2016: Journal of Extra-corporeal Technology
Marco C Stehouwer, Roel de Vroege, Johannes C Kelder, Frederik N Hofman, Bastian A de Mol, Peter Bruins
During cardiopulmonary bypass (CPB), gaseous microemboli (GME) are released into the patients' arterial bloodstream. Gaseous microemboli may contribute to the adverse outcome after cardiac surgery. Recently, two oxygenator models with or without integrated arterial filter (IAF) were designed and only differ in size, leading to a change of 20% in surface area of the hollow fibers and 25% in blood velocities. The aim of this study was to assess the air removal characteristics of the inspire oxygenators with or without IAF...
July 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
R D P Stanzel, M Henderson
Gaseous microemboli (GME) generated during cardiopulmonary bypass (CPB) can present a significant risk to patient outcomes, specifically if they are delivered to the cerebral vasculature. A number of GME sources have been identified, leading to improved clinical practice and equipment design to ameliorate the presence and intensity of GME during CPB. Recently, a number of new venous reservoir/oxygenator systems have entered the market, including the Sorin Inspire6 and Inspire8, the Terumo FX15 and FX25 and the Maquet Quadrox-i...
January 2016: Perfusion
Marco C Stehouwer, Johannes C Kelder, Willem van Oeveren, Roel de Vroege
Introduction of gaseous microemboli (GME) into the arterial line of a pediatric cardiopulmonary bypass (CPB) circuit may lead to cognitive decline and adverse outcomes of the pediatric patient.Arterial filters are incorporated into CPB circuits as a safeguard for gross air and to reduce GME. Recently, arterial filters were integrated in two neonatal oxygenators to reduce volume and foreign surface area. In this study a clinical CPB scenario was simulated. The oxygenators, the corresponding venous reservoirs and the complete CPB circuits were compared regarding air removal and bubble size distribution after the introduction of an air bolus or GME...
September 2014: International Journal of Artificial Organs
Daniel Johagen, Micael Appelblad, Staffan Svenmarker
Gaseous microemboli (GME) define small bubbles as < 200 microm in size. GME are reported to increase morbidity after cardiopulmonary bypass (CPB) and cardiac surgery. To prevent intrusion of GME into the systemic circulation during CPB, arterial line filtration is generally recommended. New trends in oxygenator design promote location of arterial filtration as an integral part of the oxygenator housing. The present experimental study aimed to evaluate the GME removal properties of an integrated arterial screen filter in a standard microporous oxygenator...
March 2014: Journal of Extra-corporeal Technology
Keith E Gipson, David J Rosinski, Robert B Schonberger, Cathryn Kubera, Eapen S Mathew, Frank Nichols, William Dyckman, Francois Courtin, Bradford Sherburne, Angelique F Bordey, Jeffrey B Gross
BACKGROUND: Numerous gaseous microemboli (GME) are delivered into the arterial circulation during cardiopulmonary bypass (CPB). These emboli damage end organs through multiple mechanisms that are thought to contribute to neurocognitive deficits after cardiac surgery. Here, we use hypobaric oxygenation to reduce dissolved gases in blood and greatly reduce GME delivery during CPB. METHODS: Variable subatmospheric pressures were applied to 100% oxygen sweep gas in standard hollow fiber microporous membrane oxygenators to oxygenate and denitrogenate blood...
March 2014: Annals of Thoracic Surgery
Mikhail Dodonov, Aldo Milano, Francesco Onorati, Bruno Dal Corso, Tiziano Menon, Daniele Ferrarini, Maddalena Tessari, Giuseppe Faggian, Alessandro Mazzucco
Cardiopulmonary bypass (CPB) has a risk of cerebral injury, with an important role of gaseous micro-emboli (GME) coming from the CPB circuit. Pulsatile perfusion is supposed to perform specific conditions for supplementary GME activity. We aimed to determine whether pulsatile CPB augments production and delivery of GME and evaluate the role of different events in GME activity during either type of perfusion. Twenty-four patients who underwent on-pump coronary artery bypass grafting surgery at the University of Verona were divided equally into two groups-pulsatile perfusion (PP) group and nonpulsatile perfusion (NP) group...
April 2013: Artificial Organs
S Doganci, S Gunaydin, O Murat Kocak, S Yilmaz, U Demirkilic
BACKGROUND: This study aimed to determine whether there was any association between the intensity of intraoperative gaseous microembolic signals (GME), neuropsychological testing and clinical outcome in high-risk patients undergoing coronary artery surgery (CABG). METHODS: Over a 6-month period, GME activity was monitored in 102 Euroscore 6+ patients during cardiopulmonary bypass (CPB) with a conventional 32-micron arterial filter by non-invasive, real-time ultrasonic device...
May 2013: Perfusion
A Strother, S Wang, A R Kunselman, A Ündar
OBJECTIVE: The purpose of this experiment was to compare the Sorin KIDS D131 and the Terumo Capiox AF02 pediatric arterial filters in a simulated CPB procedure to determine which filter is the better for clinical use. METHODS: The experimental circuit was primed with an 800 ml combination of lactated Ringer's solution and human blood (hematocrit (Hct) 30%). The two filters were tested under flow rates of 500, 1000, and 1500 ml/min at room temperature and their purge lines opened and closed as 5cc of air was injected into the circuit...
May 2013: Perfusion
R K Mathis, J Lin, N M Dogal, F Qiu, A Kunselman, S Wang, A Ündar
This study compared four pediatric cardiopulmonary bypass (CPB) circuits with four different hollow-fiber membrane oxygenators and their specific reservoirs, Capiox RX15, Quadrox-i pediatric, Quadrox-i pediatric with integrated arterial filter (IAF) and KIDS D101, in a simulated CPB circuit identical to that used in the clinical setting at our institution to test their ability to maintain hemodynamic properties, remove gaseous microemboli (GME), and to test the amount of blood "stolen" by the arterial filter purge line...
November 2012: Perfusion
Song Lou, Bingyang Ji, Jinping Liu, Kun Yu, Cun Long
Neuropsychological injury after cardiopulmonary bypass (CPB) is one of the most serious and costly complications arising from the procedure. Gaseous microemboli (GME) have long been implicated as one of the principal causes. There are two major sources of GME: surgical and manual manipulation of the heart and arteries; and the components of the extracorporeal circuit, including the type of pump, different perfusion modes, the design of the oxygenator and reservoir, and the use of vacuum assisted venous drainage (VAVD), all of which have a great impact on the delivery of existing GME to the patients...
November 2011: International Journal of Artificial Organs
N M Dogal, R K Mathis, J Lin, F Qiu, A Kunselman, A Undar
The cardiopulmonary bypass (CPB) procedure has been shown to be a possible cause of postoperative neurological morbidity for various reasons, including: large amounts of gaseous microemboli (GME) reaching the patient and hypoperfusion of the patient due to "stolen" blood flow. This study used a simulated CPB circuit identical to that in a clinical setting to examine three different hollow-fiber membrane oxygenators without intergrated arterial filters - the Capiox RX05, the Quadrox-i neonatal, and the KIDS D100 - to determine their ability to reduce the number of GME delivered to the neonatal patient and their hemodynamic properties in response to varying flow rates, normothermic vs hypothermic conditions, and open vs closed purge line...
March 2012: Perfusion
Marco C Stehouwer, Chris Boers, Roel de Vroege, Johannes C Kelder, Alaaddin Yilmaz, Peter Bruins
The use of minimized extracorporeal circuits (MECC) in cardiac surgery is an important measure to increase the biocompatibility of cardiopulmonary bypass during coronary artery bypass grafting (CABG). These circuits eliminate volume storage reservoirs and bubble traps to minimize the circuit. However, the reduction in volume may increase the risk of gaseous microemboli (GME). The MECC system as used by our group consists of a venous bubble trap, centrifugal pump, and an oxygenator. To further reduce the risk of introducing GME, an oxygenator with an integrated arterial filter was developed based on the concept of minimal volume and foreign surface...
April 2011: International Journal of Artificial Organs
Feng Qiu, Sophia Peng, Allen Kunselman, Akif Ündar
Gaseous microemboli (GME) remain a challenge for cardiopulmonary bypass (CPB) because there is a positive correlation between microemboli exposure during CPB and postoperative neurological injury. Thus, minimizing the number of GME delivered to pediatric patients undergoing CPB procedures would lead to better clinical outcomes. In this study, we used a simulated CPB model to evaluate the effectiveness of capturing GME and the degree of membrane pressure drop for a new membrane oxygenator, Capiox Baby FX05 (Terumo Corporation,Tokyo, Japan), which has an integrated arterial filter with open and closed purge line...
November 2010: Artificial Organs
Stella Yee, Feng Qiu, Xiaowei Su, Alan Rider, Allen R Kunselman, Yulong Guan, Akif Undar
The purpose of this study was to compare the HL-20 roller pump (Jostra USA, Austin, TX, USA) and Rotaflow centrifugal pump (Jostra USA) on hemodynamic energy production and gaseous microemboli (GME) delivery in a simulated neonatal cardiopulmonary bypass (CPB) circuit under nonpulsatile perfusion. This study employed a simulated model of the pediatric CPB including a Jostra HL-20 heart-lung machine (or a Rotaflow centrifugal pump), a Capiox BabyRX05 oxygenator (Terumo Corporation, Tokyo, Japan), a Capiox pediatric arterial filter (Terumo Corporation), and ¼-inch tubing...
November 2010: Artificial Organs
Arash Salavitabar, Feng Qiu, Allen Kunselman, Akif Ündar
Cardiopulmonary bypass (CPB) can be a potential cause of morbidity in patients for several reasons, including significantly higher gaseous microemboli (GME) formation than extracorporeal life support (ECLS) and physiological circulation, diverted blood flow from the patient via an open purge line of the arterial filter, and pressure drop across the oxygenator that is used in the circuit. Using a combined oxygenator and arterial filter may minimize these harmful factors and can effectively reduce the chances for postoperative morbidity...
November 2010: Perfusion
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