A simple technique to perform combined ultrafiltration

A Simplified Circuit of Modified Ultrafiltration

A simplified circuit of modified ultrafiltration (MUF) is described. The technique described is simple, inexpensive, allows both conventional ultrafiltration (CUF) and modified ultrafiltration with minimum manipulation of the circuit, allows re-institution of cardiopulmonary bypass (CPB) in an emergency, reduces the risk of air embolism and air cavitation and can be used in adults as well as children.

Simple modified ultrafiltration

After reviewing all available methods of modified ultrafiltration (MUF), an attempt was made to develop a more simplified approach to this beneficial method of post-bypass fluid removal by withdrawing blood from the right atrium and reinfusing into the aortic cannula (venoarterial). The simplicity of operation, ease of setup and analysis of hemoglobin, hematocrit, total proteins and colloid osmotic pressure, and fluid removed were examined in 12 consecutive neonatal and pediatric patients undergoing cardiac surgery. Results indicate that this simplified modified ultrafiltration (SMUF) is comparable to all other methods of MUF by achieving dramatic improvements in all parameters measured. In addition, SMUF provides the perfusionist with the ability to run conventional ultrafiltration throughout the bypass procedure, using this one circuit design. As well as finding the learning curve for SMUF to be very short, this method was found to be superior in its simplicity of operation, ease of setup, reduced risk of complications and acceptance by the surgeon and anesthetist.

A circuit to perform a combined ultrafiltration procedure in pediatric open heart surgery

Cardiopulmonary bypass (CPB) induces an increased capillary permeability and tissues water content due to hemodilution and the inflammatory response, resulting in organ dysfunction. The reduction of the water accumulation and inflammatory response can be achieved by employing ultrafiltration during CPB. Recently we developed a simple CPB circuit for ultrafiltration using the aortic venting tube as an inlet line. Such a technique offers the advantages of performing a combined ultrafiltration procedure and eliminating the danger of air embolism. We employed this circuit in 12 consecutive pediatric patients undergoing open heart surgery.