Evaluation of Neonatal Membrane Oxygenators With Respect to Gaseous Microemboli Capture and Transmembrane Pressure Gradients

Abstract

A series of studies performed at our center demonstrates that gaseous microemboli (GME) remain a challenge in cardiac surgical procedures. Evaluation of novel oxygenators must address hemodynamic parameters and microemboli capture capability. The objective of this study is to compare two neonatal membrane oxygenators, the Quadrox-i (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) and the Capiox RX05 (Terumo Corporation, Tokyo, Japan), with respect to GME capture and hemodynamic energy delivery. The experimental circuit included a Maquet HL-20 heart-lung machine, a Heater-Cooler Unit HCU 30 (MAQUET Cardiopulmonary AG), a membrane oxygenator (Quadrox-i Neonatal or Capiox RX05), and ¼-inch tubing from the COBE Heart/Lung Perfusion Pack (COBE Cardiovascular, Inc., Arvada, CO, USA). A Capiox cardiotomy reservoir CX*CR10NX (Terumo Corporation) acted as a pseudopatient. The circuit was primed with human packed red blood cells and lactated Ringer's solution and de-aired according to clinical priming procedure. Heparin (5000IU) was added into the circuit. The total volume was 400mL and hematocrit was 30%. Pump flow rate was maintained at 500 or 1000mL/min under both pulsatile and nonpulsatile modes. All trials were conducted under 100mm Hg of circuit pressure at normothermia (35°C). In each trial, bolus air (0.5mL) was injected into the circuit at the prepump site over 5s. Total emboli counts and total emboli volume were significantly reduced by the Quadrox-i Neonatal membrane oxygenator compared to the Capiox RX05 membrane oxygenator. Classification and quantification of GME detected at the postoxygenator site at two different flow rates indicated that the Quadrox-i Neonatal captures the majority of microemboli larger than 40µm in diameter. The Quadrox-i Neonatal membrane oxygenator had a higher transmembrane pressure drop at 500mL/min, whereas it had a lower pressure drop at 1000mL/min compared to the Capiox Baby RX05 oxygenator. Additionally, the Quadrox-i Neonatal oxygenator preserved more pulsatile energy than the Baby RX05 oxygenator at both flow rates. Compared to the Capiox RX05 membrane oxygenator, the Quadrox-i Neonatal membrane oxygenator has significantly improved GME handling capacity and had better hemodynamic energy preservation. Further research encompassing in vivo and clinical studies is needed to investigate the magnitude and mechanisms of these benefits.