Microbubble activity in miniaturized and in conventional extracorporeal circulation

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Medical Devices

Background:

• Miniaturized extracorporeal circulation (mECC) systems are increasingly used in cardiac surgery.
• Concerns exist regarding potential increased gaseous microembolism (GME) with mECC compared to conventional extracorporeal circulation (cECC).
• Understanding GME risk is crucial for patient safety in extracorporeal circulation.

Purpose of the Study:

• To prospectively compare GME and clinical outcomes between three mECC systems and one cECC system.
• To evaluate the microbubble activity and diameter during cardiopulmonary bypass.
• To assess the incidence of postoperative neuropsychological and renal dysfunction, hospitalization, and 30-day mortality.

Main Methods:

• A prospective, randomized study involving 93 patients undergoing elective bypass surgery.
• Comparison of three mECC systems (MECC, PRECiSe, Resting Heart) against a cECC system (HL30 Maquet).
• Ultrasound Doppler system used to detect microbubble amount and size in arterial lines; clinical outcomes analyzed.

Main Results:

• Microbubble activity was highest in the initial 10 minutes of extracorporeal circulation.
• Resting Heart system showed lower microbubble activity (p=0.01), MECC showed equal activity (p=0.16), and PRECiSe showed higher activity (p=0.002) compared to cECC.
• No significant differences were observed in microbubble diameter, postoperative neuropsychological dysfunction, renal dysfunction, hospitalization duration, or 30-day mortality between groups.

Conclusions:

• Significant variability exists in GME occurrence among different extracorporeal circuits.
• The hypothesis of an increased GME risk with mECC compared to cECC is not supported by this study's findings.
• Clinical outcomes were comparable across all tested mECC and cECC systems, suggesting safety for specific mECC devices.