Different applications of cardiopulmonary bypass systems based on common membrane oxygenator in cardiovascular surgery
Abstract
Aim – to introduce possible ways of using the cardiopulmonary bypass (CPB) systems based on the standard oxygenator.
Introducion. In аpart from classic use of heart-lung machine for extracorporeal circulation during open cardiosurgical operation we also use CPB system in three following ways: as a part of cardiopulmonary resuscitation, during percutaneous coronary interventions (PCI) in high risk patients (including those with contraindications for CABG) as some sort of safety net (some of them with modified mini-circuit system); and also for operations on aortic arch, in which cases we use modified double circuit with two independent oxygenators, developed in our hospital.
In this article we present our clinical experience and outcomes for this three groups of patients.
Material and methods. We retrospectively analysed cases of 95 patients (2011–2016). 23 of them underwent open cardiosurgical interventions in 2012–2016 and suffered cardiac arrest in postoperative period, required using of cardiopulmonary bypass due to inefficiency of standard cardiopulmonary resuscitation; 16 patients underwent PCI with CPB due to high risk of intervention and/or impossibility to perform open CABG; 56 patients with operations on aortic arch required use of cardiopulmonary bypass with our modified double circuit, which allows independent perfusion of body and brain.
Results. In all patients we used centrifugal pump (MAQUET RotaFlow) and standard oxygenator (Terumo Capiox RX 25 или Medtronic Affinity NT) with usual or modified (mini) circuits. Depending on circumstances, central cannulation (ascending aorta – right atrium) or peripheral (femoral vein and arteria) were performed. The duration of cardiopulmonary resuscitation before CPB was 26 min (20–30 min) for survivors and 33 (28–43) min for those who died. The duration of CPB was 119 min (195–327) and 290 min (280–442) respectively. After CPB was started, 16 patients were transferred to the catheterization laboratory for urgent coronary catheterization, 4 of them underwent percutaneous coronary angioplasty (PCI), 5 required redo coronary artery bypass grafting. Five patients were placed on prolonged extracorporeal membrane oxygenation (ECMO), three of them were able to be weaned off ECMO in near future. Overall survival was 39.1% (9 persons) compared to predicted 100% mortality rate.
In 16 patients with PCI performed on CPB the duration of CPB was 43±14.6 min. All interventions
were performed successfully, duration of artificial pulmonary ventilation (APV) in ICU was 5.4±
3.9, troponin level on 12th hour after surgery was 239.2±219.1 ng/ml. There were no myocardial infarctions or cerebral accidents during or after PCI. Half year survival rate was 100%.
In group of patients underwent operation on aortic arch with our modified method of CPB using double circuit the duration of CPB was 177.5 (92–312) min, time of selective antegrade cerebral perfusion (SACP) was 145 (78–220) min, intraoperative blood loss was 626.5 (300–3200) ml, duration of APV in ICU was 8.9 (3.6–106.8). Survival rate was 100%. Thanks to this method our surgeons for the first time in history were able to use strategy of open distal anastomosis simultaneously with normothermic SACP.
Conclusion. Rational, individual and creative approach to use of standard CPB systems allows to perform circulatory support in different clinical situations quickly and efficiently. In certain circumstances such systems can be used as alternative to ECMO.
Keywords:cardiopulmonary resuscitation, artificial circulation, circulatory support
For citation: Evdokimov M.E., Bazylev V.V., Rosseyikin E.V., Pantyuhina M.A. Different applications of cardiopulmonary bypass systems based on common membrane oxygenator in cardiovascular surgery. Clin Experiment Surg. Petrovsky J. 2019; 7 (3): 94–104. doi: 10.24411/2308-1198-2019-13011 (in Russian)
Received 15.02.2019. Accepted 25.07.2019.
References
1. AverinaT.B. Cardiopulmonary bypass. Annaly khirurgii [Annals of Surgery]. 2013; (2): 5–12. (in Russian)
2. Chang X., Zhang X., Li X., et al. Use of extracorporeal membrane oxygenation in tracheal surgery: a case series. Perfusion. 2014; 29: 159–62.
3. Pappalardo F., Montisci A. What is extracorporeal cardiopulmonary resuscitation? J Thorac Dis. 2017; 9 (6): 1415–9. doi:10.21037/jtd.2017.05.33.
4. Dennis M., McCanny P., D’Souza M., et al. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a multicentre experience. Int J Cardiol. 2017; 231: 131–6.
5. Spangenberg T., Meincke F., Brooks S., et al. «Shock and Go?» extracorporeal cardio-pulmonary resuscitation in the golden-hour of ROSC. Catheter CardiovascInterv.2016; 88: 691–6.
6. Shin T., Jo I., Sim M., et al. Two-year survival and neurological outcome of in-hospital cardiac arrest patients rescued by extracorporeal cardiopulmonary resuscitation. Int J Cardiol. 2013; 168: 3424–30.
7. Mazzeffi M., Sanchez P., Herr D., et al. Outcomes of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in adult cardiac surgery patients. J Thorac Cardiovasc Surg. 2016; 152: 1133–9.
8. Chou T., Fang C., Yen Z., Lee C., et al. A observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction. Emerg Med J. 2014; 31(6): 441–7.
9. Siao F., Chiu C., Chiu C., Chen Y., et al. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation. Resuscitation. 2015; 92: 70–6.
10. Belov S.I., Pasyuga V.V., Berezhnoy S.A., Klepiko- va I.V., Adzhigaliev R.R., Ibragimov S.V., Panov O.S., Cher- nov I.I., Tarasov D.G. Extracorporeal life support in the treatment of critical conditions in cardiac surgery. Clinical and Experimental Surgery. Petrovsky J. 2017; 5 (1): 37–40. (in Russian)
11. Cave D., Gazmuri R., Otto C., Nadkarni V., et al. Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122 (3): 720–8.
12. Cheng R., Hachamovitch R., Kittleson M., Patel J., et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014; 97 (2): 610–6.
13. Taub J., L’Hommedieu B., Raithel S., et al. Extracorporeal membrane oxygenation for percutaneous coronary angioplasty in high risk patients. ASAIO Trans. 1989; 35 (3): 664–6.
14. Rihal C.S., Naidu S.S., et al.; Society for Cardiovascular Angiography and Interventions (SCAI); Heart Failure Society of America (HFSA); Society of Thoracic Surgeons (STS); American Heart Association (AHA) and American College of Cardiology (ACC). 2015 SCAI/ACC/ HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care. Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology – Association Canadienne de Cardiologied’intervention. J Am Coll Cardiol. 2015; 65 (19): 7–26.
15. Ganyukov V.I., Popov V.A., Shukevich D.L., et al. In-hospital and long-term results of percutaneous coronary intervention with biventricular support and extracorporeal membrane oxygenation. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2014; (1): 15–20. (in Russian)
16. Magovern G., Simpson K. Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg. 1999; 68: 655661.
17. Osiev А.G., Baystrukov V.I., Biryukov А.V., et al. Use of extracorporeal membrane oxygenation during emergency percutaneous coronary intervention in a patient with acute myocardial infarction complicated by cardiogenic shock. Mezhdunarodniy zhurnal interventsionnoy kardioangiologii [International Journal of Interventional Cardioangiology]. 2012; (30): 46–50. (in Rus- sian)
18. Chen J., KoW., Yu H., et al. Analysis of the out-come for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med. 2006; 34: 950–7.
19. Bazylev V.V., Evdokimov M.E., Pantyukhina M.А., Morozov Z.А. Artificial circulation in high-risk percutaneous coronary interventions. Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2016; 22 (3): 112–8 (in Russian).
20. DePaulis R., Czerny M., Weltert L., Bavaria J., et al.; EACTS Vascular Domain Group. Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe. Eur J Cardiothorac Surg. 2015; 47 (5): 917–23.
21. Griepp R., Ergin M., McCullough J., Nguyen K.H., et al. Use of hypothermic circulatory arrest for cerebral protection during aortic surgery. J Cardiovasc Surg. 1997; 12 (2): 312–21.
22. Di Eusanio M., Schepens M., Morshuis W., Dossche K.M., et al. Brain protection using antegrade selective cerebral perfusion: a multicenter study. Ann Thorac Surg. 2003; 76 (4): 1181–8.
23. Kamiya H., Hagl C., Kropivnitskaya I., Böthig D., et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007; 133 (2): 501–9.
24. Pacini D., Leone A., Di Marco L., Marsilli D., et al. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiotho- rac Surg. 2007; 31 (4): 618–22.
25. Rosseykin E.V., Evdokimov M.E., Bazylev V.V., Batrakov P.A., et al. Change of paradigm in the aortic arch reconstruction – “warm head – cool body”. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2016; 16 (4): 26–33. (in Russian)
26. Rosseykin E.V., Evdokimov M.E., Bazylev V.V., Vachev S.A. Pat. RU 2596059 C2: A method for determin- ing the volumetric rate of regional blood flow for selective antegrade perfusion. Bulletin “Inventions. Utility Models”. 2016 August. No. 24.