Clinical gaseous microemboli assessment of an oxygenator with integral arterial filter in the pediatric population

The use of an arterial line filter (ALF) within the pediatric cardiopulmonary bypass (CPB) circuit is not a new concept. It has always presented the perfusionist with a circuit component that while valuable, increased prime volume. The purpose of this study was to evaluate the change in prime volume and emboli between a conventional oxygenator with separate ALF and a new generation oxygenator with integral arterial filter (AF). We performed a clinical, non-randomized retrospective evaluation of the Terumo Capiox RX15 (Terumo Cardiovascular Systems Corporation, Ann Arbor, MI) (n = 10) in conjunction with the Terumo Capiox AF125X ALF or the Capiox AF02 vs. the Terumo Capiox FX15 oxygenator with integral AF (n = 10). The above circuit components, in combination with the LUNA EDAC (emboli detection and classification) Quantifier (LUNA Innovations, Blacksburg, VA) were placed at various locations within each patient's CPB circuit to establish and quantify the presence and volume of gaseous emboli during all phases of cardiopulmonary bypass. The EDAC system is available/used for all patients undergoing CPB at this institution. When compared to a more conventional CPB circuit, the Capiox FX15 primes more easily as it does not require a carbon dioxide flush while still providing a 32 microm AF. There was no statistical difference in air handling between the tested oxygenators and their associated circuits. During this review it was determined that use of the Capiox FX15 simplifies the arterial limb of the pediatric CPB circuit. Removal of the separate ALF led to the removal of several, now unnecessary, arterial connectors and additional tubing (arterial line filter bypass). Removal of these components led to a reduction in prime volume and decreased the hemodilutional effect. The FX15 provided a safe, simplified pediatric CPB circuit and was as effective in gaseous microemboli removal as was the more traditional RX15 with separate ALF during this review.