Machine Pulsatile Perfusion Training Manual

Machine pulsatile perfusion training manual

For several years there is no conclusive guideline on the effectiveness of pulsatile or non-pulsatile perfusion during cardiopulmonary bypass CPB in patients undergoing cardiac surgeries. In this study, we evaluated the effect of pulsatile versus continuous perfusion on the myocardial release of the cardiac biochemical markers including, creatine phosphokinase CPK , cardiac creatine kinase CK-MB , and lactate dehydrogenase LDH , and also kidney function tests including: blood urea nitrogen test BUN and creatinine test Cr in patients that underwent both pulsatile and non-pulsatile methods before and after heart surgeries.

A total of 80 patients were enrolled in this study, 40 patients in each pulsatile and non-pulsatile group. There were no significant differences between the two groups with regard to preoperative parameters such as sex, age, and body surface area.

Our study shows that the effect of pulsatile perfusion on cardiac and kidney function is better than the non-pulsatile method.

Machine pulsatile perfusion training manual

Cardiopulmonary Bypass CPB , during open-heart surgeries facilitates cardiac manipulation and helps maintenance of hemodynamic stability [ 1 ]. CPB causes increased vascular permeability, release of oxygen free radicals and lysosomal enzymes from white blood cells, and endothelial damage. Even though non-pulsatile or continuous cardiopulmonary bypass CPB is used more widely than pulsatile CPB, it enhances transient dysfunction of the pulmonary system [ 2 ].

Machine Perfusion

Pulsatile CPB is considered to be more natural and beneficial than continuous perfusion, because pulsatile flow provides motion of the tissue fluid around cell membrane, improves microcirculation and increases diffusion. It also facilitates decreased systemic vascular resistance and enhanced oxygen consumption [ 3 ]. Despite accepted theoretical concepts, pulsatile CPB has not been widely used; the reason is lacking objective data on the effectiveness of this method.

Machine pulsatile perfusion training manual

This study aims to explore advantages or beneficial effects of pulsatile versus continuous perfusion during CPB in patients undergoing cardiac surgeries. In this study, in order to evaluate the effect of pulsatile versus continuous perfusion, the myocardial release of the important cardiac biochemical markers were examined, these factors are common markers of the myocardial stable state [ 4 , 5 ].

These biochemical markers include, creatine phosphokinase CPK , cardiac creatine kinase CK-MB , and lactate dehydrogenase LDH , and also kidney functional tests including: blood urea nitrogen test BUN and creatinine test Cr in patients that underwent both pulsatile and non-pulsatile methods before and after heart surgeries were examined.

Machine pulsatile perfusion training manual

Measurement of biochemical markers and kidney function after cardiovascular surgeries is routine and all patients gave an informed consent before enrolment. Anesthetic technique was standardized and performed according to a standard protocol [ 6 ]. All patients underwent central venous pressure CVP through the right internal jugular vein for continuous hemodynamic monitoring before anesthetic induction. Postoperative chest roentgenogram approved its exact positioning.

Statistical analysis was performed using a graph and data analysis software package SigmaPlot P value less than 0.

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There was no recorded case of mortality or morbidity in the two groups of patients. Cumulative cardiac biochemical markers and kidney function release were calculated as the mean net release before operation and at all 3 measuring time points after operation. Baseline characteristics of the two groups are summarized in Table 1. Both kidney function tests showed that the BUN and Cr were dysregulated more in non-pulsatile group in comparison to the pulsatile group.

Creatine phosphokinase CPK concentration in pulsatile and non-pulsatile groups, 24 h, 48 h, and 72 h after operation. Cardiac creatine kinase CK-MB concentration in pulsatile and non-pulsatile groups, 24 h, 48 h, and 72 h after operation. Lactate dehydrogenase LDH concentration in pulsatile and non-pulsatile groups, 24 h, 48 h, and 72 h after operation. In addition, same with myocardial injury markers, kidney function markers, were also dys-regulated much more in non-pulsatile group than the pulsatile group.

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Blood Cr was increased at 48 and 72 hours more considerably in non-pulsatile than in pulsatile group Figure 4. Creatinine Cr concentration in pulsatile and non-pulsatile groups, 24 h, 48 h, and 72 h after operation.

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Blood urea nitrogen test BUN concentration in pulsatile and non-pulsatile groups, 24 h, 48 h, and 72 h after operation. The literature suggests that pulsatile flow should be routinely used during CPB in moderate- to high-risk open heart surgery. In recent years, increasing evidence supports a shift toward pulsatility in open heart cardiac surgeries over non-pulsatility [ 7 ]. Clinical evidences show better cardiac, renal, and pulmonary outcomes in patients receiving pulsatile perfusion [ 8 - 10 ].

The beneficial impact of pulsatile flow include reducing the systemic inflammatory res-ponse syndrome associated with bypass, decreased need for inotropic support, shortened hospital stay, and superior organ preservation [ 9 , 11 , 12 ].

Additionally, it has been found that the use of pulsatile flow during and after pediatric open heart surgery resulted in improved patient outcomes in terms of preserving better cardiac, renal, and pulmonary functions in the early post-CPB period [ 13 ]. There is a continuing debate about the physiologic impact of non-pulsatile perfusion. Possible reasons for inconsistency and ongoing controversy could be the difference in the hemodynamic energy levels produced by specific pulsatile and nonpulsatile pumps, using improper patient-selection criteria, inappropriate manipulation of pulsatile flow during CPB, and choosing unsuitable extracorporeal-circuit components [ 14 ].

However, our results are consistent with other findings that demonstrate the effectiveness of the pulsatile perfusion.

Myocardial injury markers showed that changes in non-pulsatile method were more significant. Surprisingly, CPK-MB levels were decreased in pulsatile group at 48 h and 72 h after operation, on the contrary, its levels in non-pulsatile group were drastically increased at the same time points Figure 2. On the other side, kidney function markers showed consistent results with cardiac biochemical markers. Cr levels were increased more significantly in non-pulsatile group at 48 h and 72 h postoperatively than the pulsatile group Figure 4 In addition, BUN levels were decreased in pulsatile patients at three time points especially after 24 h; but in non-pulsatile patients its levels decreased at 24 h and increased 48 h and 72 h after operation Figure 5.

Additional information

All in all, our study shows that the effect of pulsatile perfusion on cardiac and kidney function is better than the non-pulsatile method. It would be beneficial if other studies evaluate other of circuit components and patient outcomes. Nonetheless, it has to be mention that other large-scale clinical trials would be much more confirmative. This study was supported by the research deputy for Ardabil University of Medical Sciences.

National Center for Biotechnology Information , U. Am J Cardiovasc Dis. Author information Article notes Copyright and License information Disclaimer. Address correspondence to: Dr. Received Jun 10; Accepted Aug 2. Abstract For several years there is no conclusive guideline on the effectiveness of pulsatile or non-pulsatile perfusion during cardiopulmonary bypass CPB in patients undergoing cardiac surgeries. Keywords: Cardiopulmonary bypass, pulsatile, non-pulsatile, biochemical markers, kidney function.

Introduction Cardiopulmonary Bypass CPB , during open-heart surgeries facilitates cardiac manipulation and helps maintenance of hemodynamic stability [ 1 ]. Anesthesia Anesthetic technique was standardized and performed according to a standard protocol [ 6 ].

Statistical analysis Statistical analysis was performed using a graph and data analysis software package SigmaPlot Results There was no recorded case of mortality or morbidity in the two groups of patients. Table 1 Demographics and characteristics. Open in a separate window.

Figure 1. Figure 2. Figure 3. Figure 4.

Cardiopulmonary Bypass: An Introduction

Figure 5. Discussion The literature suggests that pulsatile flow should be routinely used during CPB in moderate- to high-risk open heart surgery. Acknowledgements This study was supported by the research deputy for Ardabil University of Medical Sciences. Disclosure of conflict of interest None. References 1. A randomized trial of pulsatile perfusion using an intra-aortic balloon pump versus nonpulsatile perfusion on short-term changes in kidney function during cardiopulmonary bypass during myocardial reperfusion.

Am J Kidney Dis.

Current State of Hypothermic Machine Perfusion Preservation of Organs: The Clinical Perspective

Complications after cardiac operations in patients with severe pulmonary impairment. Ann Thorac Surg.

Machine pulsatile perfusion training manual

Comparative study of pulsatile and nonpulsatile flow during cardio-pulmonary bypass. Ann Card Anaesth. Effect of staged preconditioning on biochemical markers in the patients undergoing coronary artery bypass grafting. ISRN Cardiol. Comparison of biochemical markers for the detection of minimal myocardial injury: superior sensitivity of cardiac troponin--T ELISA.

J Intern Med. Intraaortic balloon pumping during cardioplegic arrest preserves lung function in patients with chronic obstructive pulmonary disease. Clinical outcomes of pulsatile and non-pulsatile mode of perfusion.

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J Extra Corpor Technol. Comparison of the effects of pulsatile cardiopulmonary bypass, non-pulsatile cardiopulmonary bypass and off-pump coronary artery bypass grafting on the respiratory system and serum carbonyl. Sievert A, Sistino J. A meta-analysis of renal benefits to pulsatile perfusion in cardiac surgery.

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The effects of pulsatile cardiopulmonary bypass on acute kidney injury. Int J Artif Organs. Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects. Effects of pulsatile and nonpulsatile perfusion on cerebral regional oxygen saturation and endothelin-1 in tetralogy of fallot infants. Artif Organs.

Machine pulsatile perfusion training manual

Benefits of pulsatile perfusion on vital organ recovery during and after pediatric open heart surgery. Undar A. The ABCs of research on pulsatile versus nonpulsatile perfusion during cardiopul-monary bypass.

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