Use of Spectrum Medical M3 monitor in pediatric cardiac surgery: gaseous emboli monitoring in Capiox RX05 and Capiox FX05 oxygenators

Abstract

Amac: Spectrum Medical M3 monitorunun klinik kullanimiyla birlikte arteriyel filtresiz Terumo Capiox RX05 ve entegre arteriyel filtreli Capiox FX05 oksijenatorlerde emboli monitorizasyonunun sonuclari incelendi. Ca­lis­ma­ pla­ni:­ Spectrum Medical M3 monitoru Aralik 2010 ve Haziran 2011 tarihleri arasinda 50 hastada kullanildi. Otuz hastada (grup 1; 21 erkek, 9 kiz; ort yas 26.3±12.4 ay) Capiox RX05, 20 hastada (group 2; 10 erkek, 10 kiz; ort. yas 22.4±12 ay) Capiox FX05 oksijenatoru kullanildi. Ortalama yas grup 1’de 26.3±12.4 ay, grup 2’de 22.4±12 ay idi. Heparin dozu 400 unite/kg idi. Etkinlestirilmis pihtilasma zamani >500 saniyede, hematokrit %25-30 arasinda ve kardiyopulmoner baypas debisi 125-150/mL/kg/dakikada korundu. Orta dereceli hipotermi (28-34 derece), alfa stat kan gazi yonetimi ve antegrad izotermik kan kardiyoplejisi kullanildi. Bul gu lar: Grup 1’de mortalite gozlenmedi. Grup 2’de bir hasta pulmoner hipertansiyon nedeni ile oldu. Grup 1 ve grup 2’de iki hastada pnomoni nedeni ile uzun sureli solunum destegi gerekti. Grup 1’de arteriyel gaz embolisi sayisi ortalama 32573 (2306360051) (%25-75 persentil), ortalama gaz embolisi volumu 4.2 mL (2.1-7.5 mL) (%25-75 persentil) idi. Grup 2’de arteriyel gaz embolisi sayisi ortalama 25053 (9096.3-37352.3) (%25-75 persentil), ortalama gaz embolisi volumu 1.1 mL (0.5-3.2 mL) (%25-75 persentil) (Arteriyel emboli sayisi icin p degeri 0.043, arteriyel emboli volumu icin p degeri 0.001) idi. So­nuc:­ Spectrum Medical M3 monitoru pediyatrik kalp cerrahisinde gaz embolisi monitorizasyonu icin faydali bir cihazdir. Gaz embolisinden korunmada entegre arteriyel filtreli Terumo FX05 oksijenator, arteriyel filtresi olmayan Capiox RX05 oksijenatorden daha etkili olabilir. Anah tar soz cuk ler: Kardiyopulmoner baypas; gaz embolisi; pediyatrik kalp cerrahisi. Background:­The clinical use of Spectrum Medical M3 monitor, and the results of emboli monitoring for Terumo Capiox RX05 oxygenator without arterial filter and Terumo Capiox FX05 oxygenator with built in arterial filter were evaluated. Methods: Spectrum Medical M3 monitor was used for 50 patients between December 2010 and June 2011. Capiox RX05 oxygenator was used for 30 patients (group 1; 21 boys, 9 girls; mean age 26.3±12.4 months), and Capiox FX05 oxygenator was used for 20 patients (group 2; 10 boys, 10 girls; mean age 22.4±12 months). Heparin dose was 400 units/kg. Activated clotting time was maintained at >500 seconds, hematocrit was maintained at 25-30%, and cardiopulmonary bypass flow was maintained at 125-150 mL/kg/minute. Moderate hypothermia (2834 degrees), alfa stat blood gas management, and antegrade isothermic blood cardioplegia were used. Results:­No mortality was observed in group 1. In group 2, one patient died due to pulmonary hypertension. Two patients needed prolonged respiratory support for pneumonia in group 1 and group 2. In group 1, the mean number of arterial gaseous emboli was 32573 (23063-60051) (25-75% percentile), and mean volume of arterial gaseous emboli was 4.2 mL (2.1-7.5 mL) (25-75% percentile). In group 2, the mean number of arterial gaseous emboli was 25053 (9096.3-37352.3) (25-75% percentile), and mean volume of arterial gaseous emboli was 1.1 mL (0.5-3.2 mL) (25-75% percentile) (p value for the number of arterial emboli was 0.043, and p value for arterial emboli volume was 0.001). Conclusion:­Spectrum Medical M3 monitor is a useful device for monitoring gaseous emboli in pediatric cardiac surgery. Terumo Capiox FX05 oxygenator with built in arterial filter may be more effective for the prevention of gaseous emboli than Terumo Capiox RX05 oxygenator without arterial filter.