Extracorporeal Circulation Blood Research Articles

Structure optimization design of extracorporeal circulation blood transport pump

Structure optimization design of extracorporeal circulation blood transport pump

Molecular hydrogen: prospective treatment strategy of kidney damage after cardiac surgery.

Cardiac surgery-associated acute kidney injury is a common post-operative complication, mostly due to increasing oxidative stress. Recently, molecular hydrogen (H2 gas) has also been applied to cardiac surgery due to its ability to reduce oxidative stress. We evaluated the potential effect of H2 application on the kidney in an in vivo model of simulated heart transplantation. Pigs underwent cardiac surgery within 3 h while connected to extracorporeal circulation (ECC) and subsequent 60 min of spontaneous reperfusion of the heart. We used two experimental groups: T-pigs after transplantation and TH-pigs after transplantation treated with 4% H2 mixed with air during inhalation of anesthesia and throughout oxygenation of blood in ECC. The levels of creatinine, urea and phosphorus were measured in plasma. Renal tissue samples were analyzed by Western blot method for protein levels of nuclear factor erythroid 2-related factor 2 (Nrf2), Kelch-like ECH-associated protein 1 (Keap-1), and superoxide dismutase (SOD1). After cardiac surgery, selected plasma biomarkers were elevated. However, H2 therapy was followed by the normalization of all these parameters. Our results suggest activation of Nrf2/Keap1 pathway as well as increased SOD1 protein expression in the group treated with H2. The administration of H2 had a protective effect on the kidneys of pigs after cardiac surgery, especially in terms of normalization of plasma biomarkers to control levels.

Efficacy of peripheral arterial access for peripheral blood stem cells collection.

Transplantation of peripheral blood stem cells (PBSCs) mobilized by cytokines is increasingly applied to treat patients with hematologic diseases, such as lymphoma, multiple myeloma, leukemia, etc. Successful hematopoietic stem cell transplantation (HSCT) increasingly depends on the collection of hematopoietic stem cells (HSCs) from peripheral blood. Peripheral vein (PV) is the most common type of blood access. When the blood vessels are not well filled and the blood flow is insufficient, the machine will appear repeated low pressure alarm or pipeline coagulation, which seriously affects the collection efficiency. A peripheral artery (PA) is utilized for drawing blood, while a peripheral vein is used for blood return, that is a way to perform apheresis. The advantages of PA are that it ensures adequate extracorporeal circulation blood flow, stable blood flow rate, simple operation, and relatively low price. However, there are very few studies on the efficacy of peripheral arterial access for HSCs collection. Therefore, this retrospective study was conducted to assess the effectiveness of PA and PV access for PBSCs collection. We performed a retrospective analysis of 150 apheresis procedures on 26 patients and 95 healthy donors collected by PV or PA access from March 1, 2020 to March 1, 2021. We compared the CD34+ cell count, collection efficiency (CE), duration of processing a single blood volume, number of low-pressure alarms, average blood flow rate and number of punctures between the two groups. Also, we analyzed adverse events. There was no significant difference in the quality of apheresis blood components between the PA group and the PV group. The CD34+ cells collected was 274.16 ± 216.31 × 106 in the PV group and 246.63 ± 127.94 × 106 in the PA group. The CE in the PA group was 49.50 ± 9.88%, higher than 42.39 ± 14.62% in the PV group. The duration of processing a single blood volume was 90.67 ± 15.35 min in the PV group and 79.68 ± 10.28 min in the PA group. The number of low-pressure alarms in the PA group was 0.38 ± 0.98, <2.42 ± 1.76 in the PV group, and the average blood flow rate in the PA group was 59.27 ± 2.18, higher than 54.21 ± 3.41 in the PV group. The difference was statistically significant (P < .05). The Number of punctures was 1.35 ± 0.75 in the PA group and 1.41 ± 1.01 in the PV group. There was no statistically significant difference. Peripheral artery is a safe, reliable, economical, convenient, and fast vascular access, which opens a new way to the establishment of vascular access for PBSCs collection.

On the Development of an Instrument for In-Line and Real-Time Monitoring of Blood-pH in Extracorporeal Circulation

The possibility of real-time monitor critical care analytes, such as pH, is recognized to provide relevant information for the diagnosis and treatment of a variety of disorders and would be of considerable support for the management of extracorporeal circulation (ECC). However, despite that blood pH can be measured from a long time by using electrodes or point-of-care instruments, such as blood-gas analyzers, costs, and complications associated with such measurement methods limit their use, thus, blood pH is generally not monitored during routinary ECC. In this article, we propose to exploit the tubing composing the ECC line to realize a low-cost and disposable pH-sensor and to interrogate such fluorescent sensors by using optical radiations. The proposed measuring system avoids complications related to blood sampling and may allow achieving single-patient cost requirements. Preliminary tests performed on a real ECC bloodline demonstrate that the system can operate with blood in ECC. Indeed, a 6-h ECC treatment simulated using bovine blood revealed a deviation with respect to the reference pH-meter typically of about a few thousandths pH and with a maximum of about 0.01 pH.

Design and application of an arterial circulation routes for hemodialysis without heparin

Objective To evaluate the effect of improved extracorporeal circulation blood route for prevention of complications in patients with chronic kidney disease (CKD) on hemodialysis. Methods A total of 80 cases of CKD patients were selected from June 2016 to June 2017.According to the random number table method, they were divided into the observation group and the control group, 40 cases of each group.The control group was treated with traditional one time hemodialysis pipeline during hemodialysis, while the observation group was treated with improved vascular access during hemodialysis.The complications and patient satisfaction during hemodialysis were compared between the two groups. Results The operation time, blood transfusion time and pre-punching time of observation group were shorter than those of the control group (P<0.05), the amount of saline of observation group was less than that of the control group (P<0.05). The amount of arterial backflow was higher than that of the control group (P<0.05). The incidence of adverse reactions such as coagulation, catheter related infection, circulating blood route exposure to air, oozing blood and arterial end prolapse in the observation group were lower than those in the control group(P<0.05). Degree of satisfaction in the observation group was higher than that of the control group(P<0.05). Conclusions Improved extracorporeal circulation blood route for heparin-free hemodialysis can effectively shorten the operation time of hemodialysis, reduce the incidence of coagulation in heparin-free hemodialysis apparatus and the risk of bloodstream infection, and the operation is safe and simple. Key words: Improved heparin-free hemodialysis; Extracorporeal circulation; Chronic kidney disease; Complication; Degree of satisfaction

Detection of Apolipoprotein E Gene Polymorphism and Blood Lipid Level in Hemodialysis Patients.

BackgroundThe aim was to investigate the clinical characteristics of lipid metabolism and the effect of apolipoprotein E (ApoE) gene polymorphism on lipid metabolism in hemodialysis patients.MethodsThe serum levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), ApoA1, ApoB, ApoE and lipoprotein Lp(a) were detected by polymerase chain reaction-restriction fragment length (PCR-RFLP).ResultsThe level of serum TG was significantly increased and the level of HDLC was significantly decreased in hemodialysis patients. Serum TG level was 33% higher than normal, and HDLC was 10.4% less than normal. The correlation analysis showed that TG level was significantly correlated with serum albumin level and extracorporeal circulation blood flow during dialysis. HDLC was significantly correlated with KT/V. The incidence of hypertension in hemodialysis patients was 73.6% and cardiovascular disease was 25%. The level of TG in the cardiovascular disease group was significantly higher than that in the non-cardiovascular disease group, and there was no significant difference between the hypertensive group and the non-hypertensive group. ApoE gene polymorphism test showed that the frequency of ApoE genotype ε3/3 and allele ε3 was the highest in hemodialysis patients, and the levels of TC, TG and LDLC were higher in ApoE genotype ε3/4 + ε4/4.ConclusionThe levels of serum TG and ApoB were significantly increased in patients with hemodialysis, and HDLC and other indexes were significantly decreased. The level of TG in patients with cardiovascular complications was significantly higher than in patients without complications. TG level was significantly correlated with serum albumin level and extracorporeal circulation blood flow during dialysis. HDLC was significantly correlated with KT/V. Hemodialysis patients who had ApoE allele ε4 are prone to lipid metabolism disorders.

Intracellular Phosphate Dynamics in Muscle Measured by Magnetic Resonance Spectroscopy during Hemodialysis

Of the 600-700 mg inorganic phosphate (Pi) removed during a 4-hour hemodialysis session, a maximum of 10% may be extracted from the extracellular space. The origin of the other 90% of removed phosphate is unknown. This study tested the hypothesis that the main source of phosphate removed during hemodialysis is the intracellular compartment. Six binephrectomized pigs each underwent one 3-hour hemodialysis session, during which the extracorporeal circulation blood flow was maintained between 100 and 150 ml/min. To determine in vivo phosphate metabolism, we performed phosphorous ((31)P) magnetic resonance spectroscopy using a 1.5-Tesla system and a surface coil placed over the gluteal muscle region. (31)P magnetic resonance spectra (repetition time =10 s; echo time =0.35 ms) were acquired every 160 seconds before, during, and after dialysis. During the dialysis sessions, plasma phosphate concentrations decreased rapidly (-30.4 %; P=0.003) and then, plateaued before increasing approximately 30 minutes before the end of the sessions; 16 mmol phosphate was removed in each session. When extracellular phosphate levels plateaued, intracellular Pi content increased significantly (11%; P<0.001). Moreover, βATP decreased significantly (P<0.001); however, calcium levels remained balanced. Results of this study show that intracellular Pi is the source of Pi removed during dialysis. The intracellular Pi increase may reflect cellular stress induced by hemodialysis and/or strong intracellular phosphate regulation.

Anin vitroModel of a System of Electrical Potential Compensation in Extracorporeal Circulation

Extracorporeal circulation (ECC) in patients undergoing cardiac surgery induces systemic immune-inflammatory reaction that results in increased postoperative morbidity. Many factors are responsible for the adverse response after ECC. The present in vitro study aimed to investigate electric charges (ECs) generated during ECC, to set a device compensating the ECs, and checking its effect on red blood cells (RBC). The electrical signals of blood in ECC were collected by a custom developed low-noise electronic circuit, processed by a digital oscilloscope (DSO) and a dynamic signal analyzer (DSA). The compensation of ECs was performed using a compensation device, injecting a nulling charge into the blood circuit. The compensation effect of the ECs on RBCs was evaluated by scanning electron microscope (SEM). The electrical analysis performed using both the DSO and the DSA confirmed the EC formation during ECC. The notable electric signals recorded in standard ECC circuits substantially nulled once the compensation device was used, thus confirming efficient EC compensation. After two hours of ECC, the SEM non-blended test on human RBC samples highlighted morphological changes in acanthocytes of the normal biconcave-shaped RBC. The outcomes confirm the development of parasitic ECs during ECC and that a suppressor system may decrease the potential damage of ECs. Nevertheless, further studies are ongoing in order to investigate the complex mechanisms related to lymphocytes and platelet morphological and physiological chances during triboelectric charges in ECC.

Nuclear factor κB mediates a procoagulant response in monocytes during extracorporeal circulation

Objective: The objective of this study was to examine the mechanism of procoagulant activity and inhibition in whole blood during extracorporeal circulation. Methods: In this study we examine the development of procoagulant activity and monocyte activation in heparinized whole blood passing through a closed circuit consisting of a pump and silicone envelope membrane oxygenator for 6 hours. Results: Anaphylatoxins, C3a and C5a, determined by means of enzyme-linked immunosorbant assay, appeared in the blood within 30 minutes of circulation. Circulated blood developed a marked potential for coagulation demonstrated in a 1-step clotting assay that reached maximal activity by 4 hours of circulation. This procoagulant activity was neutralized by anti-tissue factor antibody, suggesting a prominent role for the extrinsic pathway in pump-induced intravascular coagulation. Isolation of monocytes from circulated blood revealed that tissue factor expression is upregulated on the cell surface. Furthermore, we observed nuclear factor κB nuclear translocation in monocytes from blood passing through the circuit, suggesting that tissue factor expression was due to monocyte stimulation and transcriptional activation of the tissue factor gene. Tissue factor expression resulted in an approximately 30-fold increase in thrombin generation. Monocyte nuclear factor κB activation, monocyte tissue factor expression, thrombin generation, and the procoagulant activity of blood in extracorporeal circulation were all blocked by the proteasome inhibitor MG132. Conclusions: We conclude that intravascular tissue factor expression during extracorporeal circulation of blood is due to nuclear factor κB-mediated activation of monocytes (possibly by complement), which can be controlled pharmacologically.J Thorac Cardiovasc Surg 2003;125:165-71

新生児，乳児期体外循環における充填血液に対する血液ろ過法の有用性の検討

新生児,乳児における血液充填体外循環では,保存血液を使用するため体外循環開始後のinitial shockや,電解質異常などの問題があることは知られている。我々は,充填血液に対して血液濾過法(以下,HF)を使用した9例(以下,H群)と,HFを使用しなかった9例(以下,N群)を比較検討した。灌流圧は,N群に対して且群が終始10mmHg前後高く保つことができ,尿量もH群で有意に増量が認められた。また,体外循環開始時のK+値も且群の方が適正であった。その結果,新生児,乳児の体外循環を安全に行うために充填血液に対するHF方は,有用であると考えられた。

Plateletapheresis with “Haemonetics 30” through a new three-way reinfusion set®

The main disadvantages of the discontinuous flow cell separator Haemonetics 30 (Haemonetics Corp. Natick, Mass.) compared to continuous flow separators are that there is a longer course procedure and a larger amount of donor's blood in extracorporeal circulation. These drawbacks can be reduced by means of a simple technical set-up. Since plasma reinfusion may commence as soon as the bowl filling stage is completed, the amount of blood in extracorporeal circulation can be greatly reduced simply by substituting a three-way setfor the two-way reinfusion set (BT 293).

Plasmapheresis of Horses by Extracorporeal Circulation of Blood

A simple apparatus is described for the collection of plasma from horses while maintaining their blood in extracorporeal circulation. Using this device, nearly 2.5 kg of plasma protein was collected from a horse during a period of 3 weeks without any obvious adverse effect upon the animal. The blood’s packed cell volume showed little variation throughout this period, although its content of plasma protein was found to fall. The normal plasma protein level was almost completely re-established after 3 weeks rest. A horse immunized with tetanus toxoid and subjectcd to repeated cycles of plasmapheresis showed a steady Jail in antibody titre.

Experimental study of air bubbles in a simulated cardiopulmonary bypass system with flow constriction

An experimental study is performed to examine the breaking of an air bubble in the flow passage of a simulated cardiopulmonary bypass system by means of a flow constriction. The purpose of the study is to discover a geometry of the flow constriction which is efficient in breaking air bubbles while providing the least resistance to the flow of blood, i.e. to develop a new device for the oxygenation of the blood in extracorporeal circulation. Both plasma and water are used in the study. The use of plasma is to simulate the principal transport properties of the human blood and enable direct visualization of bubbles. Water is used for comparison with plasma to determine the influence of fluid properties on the breaking of bubbles. Several different shapes of flow constriction are tested. It is observed that as a result of rapid changes in the liquid pressure and bubble shape, an air bubble breaks into many bubbles at downstream from the flow constriction. The results are quantatively expressed by the number of baby bubbles vs. the flow rate. It is disclosed that the flask-shape constriction is efficient in breaking air bubbles while providing ideal passage for the flow of blood. The number of baby bubbles is found to increase with an increase in the fluid viscosity.

Metabolic Considerations of Acid-Citrate-Dextrose Stored Blood for Extracorporeal Circulation

Metabolic Considerations of Acid-Citrate-Dextrose Stored Blood for Extracorporeal Circulation

血液保存の研究ヘパリン加血, デキストラン硫酸加血およびマンニットール添加血の保存について

It has recently become one of the major difficulties to obtain sufficient amount of heparinized blood for extracorporeal circulation in the field of open heart surgery. The auther carried out several kinds of experimental study and hematological investigations were made on these ploblems as follows: the maximal preservation period of heparinized blood, evaluation of synthetized dextran sulphate as an anticoagulant reagent, mannitol added blood minimizing hemolysis during transportation, addition of dextran for blood preservation and preservation of blood with dextran added.The conclusions induced by the series of the study were: 1) Considering the diminution of titer of the anticoagulant reagents the maximal effective period was three days and the safety period was up to 48 hours when the amount of anticoagulant reagent was properly increased for the group in which 10mgm of heparin was contained in 100ml of blood. 2) Noticed no significant difference between dextran and glucose solution when these solutions were added to heparinized blood. 3) Anticoagulability of dextran sulphate was very similar to heparin and it was almost equivalent to heparin if the preservation period was within three days. 4) Less hematological change was observed with glucose solution than dextran when added to blood with dextran sulphate. Rather remarkable hematological alteration was seen after three days as dextran was chosen. 5) Only minimal hematological change was noted within 24 hours when heparin was prescribed 5mgm per 100ml of blood. Therefore, this prescription was good enough for clinical purpose if the blood was used as soon as possible after beeing drawn. 6) Mannitol did not produce any remarkable change from the point of blood preservation. 7) No possible way was found to prolong the preservation period of heparinized or dextran sulphate added blood.

Survival after extracorporeal circulation of stored erythrocytes treated with acid-citrate-dextrose (ACD) and heparin

Summary Studies were performed with radiochromium tagged erythrocytes in 31 patients to evaluate 24 hour old stored blood treated with heparin and with ACD. The regression curves were the same as those obtained in control patients in whom stored heparin and ACD treated erythrocytes were injected following the completion of open heart operations. This study gave additional opportunity to demonstrate the safety and practicality of employing converted ACD stored blood for extracorporeal circulation.

Studies on the use of ACD blood in extracorporeal circulation in ten consecutive dogs.

Seidenstein, Martin M.D.; Stuckey, Jackson H. M.D.; Venerose, Robert S. M.D.; Karlson, Karl E. M.D. Author Information

Experience with Edglugate-Mg donor blood for extracorporeal circulation and ordinary transfusion.

Experience with Edglugate-Mg donor blood for extracorporeal circulation and ordinary transfusion.

The effect of heparin on the platelet count in vitro, with particular reference to the collection of blood for extracorporeal circulation.

The effect of heparin on the platelet count in vitro, with particular reference to the collection of blood for extracorporeal circulation.

An Oxygenator with Increased Capacity: Multiple Vertical Revolving Cylinders.

Conclusions1. An oxygenator consisting of 8 concentric revolving cylinders which utilizes a funnel to deliver the blood into a small cup is described.2. Animal perfusions demonstrate that its efficiency as an oxygenator is high enough to make it possible to perfuse the entire animal body without using an impractically large amount of blood in extra-corporeal circulation.