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Prolonged partial venoarterial bypass: physiologic, biochemical, and hematologic responses.

R H Bartlett, S W Fong, N E Burns

    Annals of Surgery
    |December 1, 1974
    PubMed
    Summary

    This study assessed prolonged veno-arterial extracorporeal circulation in sheep, finding normal hemodynamics and minimal organ damage. Coagulation and platelet changes were observed, with recovery post-procedure.

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    Area of Science:

    • Cardiovascular physiology
    • Biomedical engineering
    • Hematology

    Background:

    • Veno-arterial extracorporeal circulation (VA-ECC) is a critical support method.
    • Understanding its effects on organ function and coagulation is vital for clinical application.
    • Previous studies often involved anesthesia or shorter durations.

    Purpose of the Study:

    • To evaluate the physiological and hematological effects of prolonged VA-ECC in awake animals.
    • To assess organ function (hemodynamics, pulmonary, renal) and markers of organ damage.
    • To characterize changes in coagulation and platelet parameters during and after VA-ECC.

    Main Methods:

    • Normal, unanesthetized sheep underwent 48-hour VA-ECC (50-80% cardiac output).
    • Serial measurements included hemodynamics, pulmonary/renal function, serum enzymes, coagulation factors, and platelets.

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  • Heparin was used to maintain activated clotting time at 2-3 times baseline.
  • Blood contact surfaces were primarily polyvinyl chloride and silicone rubber, with limited use of bubble oxygenators.

    • Main Results:

    • Hemodynamics remained normal throughout the 48-hour period.
    • Mild respiratory alkalosis and negligible hemolysis were noted.
    • Serum enzymes showed slight, gradual increases, indicating minimal organ damage.
    • Coagulation studies revealed an initial decrease in factors, followed by normalization during ECC.
    • Platelet counts decreased initially but increased to twice the normal level post-ECC.
    • Fibrinogen levels also increased post-procedure.

    Conclusions:

    • Prolonged VA-ECC is well-tolerated in awake sheep with minimal impact on hemodynamics and organ function.
    • Significant, reversible alterations in coagulation and platelet dynamics occur during and after VA-ECC.
    • These findings support the potential for extended use of VA-ECC with careful monitoring.