Haemocompatibility of membrane and bubble oxygenators

Abstract

During clinical hypothermic cardiopulmonary bypass (CPB), the haemocompatibility of six groups of membrane oxygenators (Cobe CML2, Shiley M2000, Maxima, Bard HF4000, Bard HF5000, Capiox E has been studied in 60 patients having open-heart surgery. A standardized anaesthetic and perfusion protocol was used, during which the abilityof the perfusionist to achieve target blood gas values (PaO2 20kPa and PaCO2 5.3kPa: alpha-stat) using inline electrodes was assessed. Haemocompatibility was evaluated by measurement of platelet numbers and function, betathromboglobulin (BTG), plasma haemoglobin, complement (C3a des Arg) and white blood cell (WBC) count pre- and post-CPB. Platelet and WBC numbers were also measured every five minutes throughout CPB. All oxygenators allowed the perfusionist to control blood gases adequately to prescribed levels. There were only minor differences in the degree and pattern of platelet depletion, reduction in platelet aggregation, elevation of BTG and C3a des Arg observed between oxygenator groups, which did not appear to be influenced by membrane type (flat plate versus hollow fibre). The membrane oxygenator haematological data was amalgamated with that obtained in previous clinical studies using membrane and bubble oxygenators (Cobe CML, Polystan Venotherm, Harvey H 1700, Bentley BIO-10, Bentley 1 0B, Bentley 1 OPlus, Gambro 10 and Shiley S100A HED) in which a similar evaluation protocol was employed. Comparison of the percentage change in platelet count when the pre- and post-CPB values were compared, demonstrated statistically significantly less platelet depletion (p <0.001 ) in the membrane oxygenator groups (-0.2 ± 8.3%) when compared to the bubble oxygenator groups (-21.7 ± 8.7%). A significantly lower percentage rise in BTG was also observed in the membrane oxygenator group when compared to the bubble oxygenator groups (p <0.001 ). All oxygenator groups showed elevation of both WBC count and plasma haemoglobin with a nonspecific fall in platelet aggregation over the period of bypass but no significant differences could be found between the two types of oxygenator. Membrane oxygenators, when compared to bubble oxygenators, exhibit lower GME production and improved haemocompatibility and allow superior blood gas control. Membrane oxygenators manifestly must be the oxygenator type of choice for clinical CPB.