Membrane versus bubble oxygenator in hyperthermic regional perfusion: a prospective randomized clinical study

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Perfusion Technology

Background:

• Bubble oxygenators have been routinely used in hyperthermic isolated extremity perfusion.
• Potential differences in patient outcomes between bubble and membrane oxygenators were not well-established.
• Optimizing oxygenation and minimizing cellular damage are critical during perfusion procedures.

Purpose of the Study:

• To compare the performance of a bubble oxygenator (Bentley-5) versus a hollow fiber membrane oxygenator (D 701 Masterflo 34).
• To evaluate differences in hemolysis, cellular damage, oxygenation, and temperature control during extremity perfusion.
• To determine the optimal oxygenator for hyperthermic isolated extremity perfusion.

Main Methods:

• Prospective randomized clinical study involving 30 perfusions.
• Blood samples analyzed for plasma hemoglobin (Hb), serum lactate dehydrogenase (s-LDH), erythrocytes, mean corpuscular volume (MCV), hemoglobin, bilirubin, leukocytes, and platelets.
• Blood gases (PO2, PCO2), O2 saturation, pH, temperature, and perfusion time were monitored.

Main Results:

• Membrane oxygenators showed significantly lower hemolysis (s-LDH and plasma Hb, p < 0.001).
• Reduced cellular damage observed with membrane oxygenators, particularly with platelets (p < 0.01).
• Superior and more controllable oxygenation and hyperthermia achieved with membrane oxygenators; smaller priming volume (750 vs. 1,200 ml) and closed system improved safety.

Conclusions:

• Hollow fiber membrane oxygenators are superior to bubble oxygenators for hyperthermic isolated extremity perfusion.
• Membrane oxygenators offer significant advantages in reducing hemolysis and cellular damage.
• The study recommends adopting membrane oxygenators as the new standard for this procedure.