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Comparative study of pulsatile and nonpulsatile flow during cardio-pulmonary bypass
Pardeep Poswal1, Yatin Mehta, Rajeev Juneja
1Department of Anaesthesiology, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India.
Annals of Cardiac Anaesthesia
|September 11, 2007
Summary
Pulsatile cardiopulmonary bypass (CPB) offers theoretical advantages over nonpulsatile flow. This study found pulsatile CPB slightly improved kidney function, indicated by better creatinine clearance and urine output, with no significant differences in other measured parameters.
Area of Science:
- Cardiovascular Surgery
- Extracorporeal Circulation
- Physiology
Background:
- Nonpulsatile flow is common in extracorporeal circulation, yet pulsatile cardiopulmonary bypass (CPB) is considered more physiological.
- Pulsatile CPB may enhance microcirculation, vascular patency, and cellular diffusion.
- This study investigates the clinical impact of pulsatile versus nonpulsatile flow during CPB.
Purpose of the Study:
- To compare the effects of pulsatile and nonpulsatile CPB on coagulation, liver and kidney function, and hemodynamics.
- To evaluate patient outcomes in coronary artery bypass grafting (CABG) under different CPB flow modes.
Main Methods:
- A randomized controlled trial involving 100 patients (35-65 years) undergoing CABG with normal left ventricular function.
- Patients were divided into pulsatile (P) and nonpulsatile (NP) flow groups.
- Hematological, coagulation, renal, hepatic, and hemodynamic parameters were measured preoperatively and postoperatively.
Main Results:
- Platelet counts decreased in both groups during and after CPB.
- Coagulation profiles and liver function tests showed no significant differences between groups.
- Creatinine clearance and urine output were significantly better in the pulsatile group on postoperative day 1.
Conclusions:
- Pulsatile CPB demonstrated improved renal function (creatinine clearance, urine output) compared to nonpulsatile CPB.
- No significant differences were observed in coagulation, liver function, or overall hemodynamics.
- Pulsatile flow may offer specific renal benefits during CPB in CABG patients.
