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Microemboli generation, detection and characterization during CPB procedures in neonates, infants, and small children
Khin N Win1, Shigang Wang, Akif Undar
1Department of Pediatrics, Pediatric Cardiac Research Laboratories, Penn State Milton S. Hershey Medical Center, Penn State College Medicine, Penn State Children's Hospital, Hershey, Pennsylvania 17033-0850, USA.
Abstract:
In our laboratory, we study different factors that influence the microemboli counts in the extracorporeal circuit using a simulated pediatric cardiopulmonary bypass (CPB) model identical to the one used in our operating rooms. For monitoring and classification of microemboli, we use the novel Emboli Detection and Classification (EDAC) Quantifier system which allows for real-time monitoring, localization, and size characterization of microemboli as small as 10 microm. Our results show that high flow rates, low perfusate temperature, use of vacuum assisted venous drainage (VAVD), use of roller pump, and pulsatile flow results in higher microemboli counts at postpump site. Microemboli counts at postoxygenator, and postfilter sites are significantly less. This indicates that hollow fiber membrane oxygenator was able to remove most of the microemboli, and an opened arterial filter purge line augments the removal of microemboli that were not captured by the oxygenator. Majority of the microemboli detected at all sites were <40 microm in size. Based on the results of our studies, we started using the EDAC Quantifier system in our operating rooms at Penn State Hershey Children's Hospital. More basic science studies and clinical outcome data are needed for further study in minimizing the adverse effects of pediatric CPB procedure.
Insights
High flow rates and specific equipment during pediatric cardiopulmonary bypass (CPB) increase microemboli. However, oxygenators and filters effectively reduce these particles, with most being small.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Pediatric cardiopulmonary bypass (CPB) involves complex extracorporeal circuits.
- Microemboli generation and clearance are critical concerns in CPB.
- Real-time monitoring of microemboli is essential for patient safety.
Purpose of the Study:
- To investigate factors influencing microemboli counts in a simulated pediatric CPB model.
- To evaluate the efficacy of the Emboli Detection and Classification (EDAC) Quantifier system.
- To assess the performance of oxygenators and filters in microemboli removal.
Main Methods:
- Utilized a simulated pediatric cardiopulmonary bypass (CPB) model.
- Employed the novel Emboli Detection and Classification (EDAC) Quantifier system for real-time monitoring.
- Analyzed microemboli counts at various sites within the extracorporeal circuit under different conditions.
Main Results:
- High flow rates, low perfusate temperature, vacuum-assisted venous drainage (VAVD), roller pumps, and pulsatile flow increased postpump microemboli counts.
- Microemboli counts were significantly lower postoxygenator and postfilter.
- The majority of detected microemboli were smaller than 40 micrometers.
Conclusions:
- Hollow fiber membrane oxygenators effectively remove microemboli.
- An open arterial filter purge line enhances microemboli removal.
- The EDAC Quantifier system is now used clinically; further research is needed to minimize CPB-related adverse effects.
