An ultrafiltration catheter for monitoring of venous lactate and glucose around myocardial ischemia

Abstract

Early detection of myocardial ischemia is of major importance in critical-care medicine. Changes of lactate or glucose levels in the cardial venous efflux may be useful parameters. We succeeded in integrating an ultrafiltration membrane in a cardiac catheter for continuous sampling. The ultrafiltrate was analyzed outside the body, resulting in a lag-time of about 24 min. Biosensors in a flow-injection analysis system were used for minute by minute sample analyses. The coronary sinus of pigs was catheterized to monitor the effects of 5, 15 or 45 min ischemia by coronary artery obstruction or myocardial stress by dobutamine infusion. A total of 27 h was monitored. The intravascular response time was 1.33±0.61 min (10–90%). Linear regression in vivo of blood and ultrafiltrate samples was 0.977 for lactate and 0.994 for glucose. Lactate levels rose 0.38±0.10 mM above baseline within 5 min after ischemia. Reperfusion was clearly marked by a promptly peaking lactate release (maximum 9.27 mM). Myocardial stress by dobutamine increased glucose but not lactate levels. Once, a wall effect was noted at the catheter tip. In vivo semi-continuous myocardial monitoring of absolute lactate and glucose concentrations was thus achieved by an ultrafiltration catheter. Ischemia and reperfusion can be detected very early by a lactate level rise. Further, development of the ultrafiltration catheter will be focused on the diagnostic potential of lactate monitoring for patients.