Sterility and performance of open and closed extracorporeal circuits after long-term dry-wet setups.

Autor: Deptula J; Department of Pediatric Cardiac Surgery, Levine Children's Hospital, Charlotte, NC, USA., McGrath C; Department of Pediatric and Adult Congenital Cardiac Surgery, MemorialCare Heart and Vascular Institute, Long Beach, CA, USA., Preston T; Innovative ECMO Concepts Inc, Arcadia, OK, USA., Miller H; Innovative ECMO Concepts Inc, Arcadia, OK, USA., Yen B; Department of Pediatric and Adult Congenital Cardiac Surgery, MemorialCare Heart and Vascular Institute, Long Beach, CA, USA., Munari L; Department of Pediatric and Adult Congenital Cardiac Surgery, MemorialCare Heart and Vascular Institute, Long Beach, CA, USA., Setty SP; Department of Pediatric and Adult Congenital Cardiac Surgery, MemorialCare Heart and Vascular Institute, Long Beach, CA, USA.; Cardiovascular Surgery, Long Beach Memorial Hospital and Miller Children's and Women's Hospital, Long Beach, CA, USA.
Jazyk: angličtina
Zdroj: Perfusion [Perfusion] 2021 Mar; Vol. 36 (2), pp. 130-137. Date of Electronic Publication: 2020 Jul 08.
DOI: 10.1177/0267659120937898
Abstrakt: Background: The timeframe for safely using previously setup dry, crystalloid, and blood-primed extracorporeal circuits has long been debated. This study was undertaken to determine a safe deviation from standardized recommendations.
Methods: Open (cardiopulmonary bypass) circuits and closed extracorporeal membrane oxygenation circuits were setup dry for up to 60 days and wet primed for up to 6 weeks with one control inoculated with Escherichia coli . Open circuits were cultured daily, closed circuits weekly. Circuits were primed with blood, albumin, heparin, NaHCO 3 , and CaCl 2 . Baseline pCO 2 , pO 2 , hemoglobin, lactate dehydrogenase, and plasma free hemoglobin were measured. Circuits were recirculated at a blood flow of 6 Liters/minute with a sweep gas of 1 Liter/minute at 100% FiO 2 for 1 minute. Post oxygenator blood gases were collected at 8-, 16-, and 24-hour intervals.
Results: There was no observed compromise to the sterility of the circuits and no clinically significant gas exchange abnormalities observed over the duration of the study period. Statistical significance (p < 0.01) was seen in free hemoglobin and lactate dehydrogenase levels, most significant in between the 16- and 24-hour time point in the closed systems intentionally inoculated with E. coli .
Conclusion: Open and closed circuits can be safely setup dry for up to 60 days. Open, wet-primed circuits can be used safely up to 5 days. Closed, wet-primed circuits can be used safely up to 6 weeks. Blood-primed circuits can be safely run up to 16 hours prior to patient use but should be validated in a randomized clinical study.
Databáze: MEDLINE
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