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Kashyap NK, Mehsare P, Saurabh G, Chakraborty N, Wasnik M. Central Aortic Cannula Disruption Following Left Atrial Myxoma Excision. Cureus 2023; 15:e41908. [PMID: 37583721 PMCID: PMC10423941 DOI: 10.7759/cureus.41908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Central aortic cannulation is used to give oxygenated blood to the patient through a heart-lung machine. Central aortic cannula disruption during cardiopulmonary bypass (CPB) is a rare complication. This could result in aortic dissection, extensive tears, bleeding, posterior aortic wall injury, oesophageal trauma, and cardiac arrest. We are reporting a central aortic cannula disruption during a left atrium (LA) myxoma excision in which the metal tip part of the cannula detached from its body, resulting in massive blood loss. The intraoperative blood salvage technique was used to maintain hemodynamics during surgery. Pre-procedural visual inspection of all cardiac consumables, including cannula, should be performed to eliminate this complication. All surgical team members should be observant to avoid such complications.
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Affiliation(s)
- Nitin Kumar Kashyap
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pranay Mehsare
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Gaind Saurabh
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Nirupam Chakraborty
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Minal Wasnik
- Transfusion Medicine & Blood Bank, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Jahren SE, Jenni H, Roesch Y, Arn R, Tevaearai H, Obrist D, Carrel T, Erdoes G. The impact of roller pump-assisted cardiotomy suction unit on hemolysis. Artif Organs 2020; 45:46-54. [PMID: 32619302 DOI: 10.1111/aor.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
Abstract
Hemolysis in cardiac surgery is often related to the contact of blood with air or artificial surfaces. Variations of negative pressure in the suction cannulas may represent an additional factor. Limited data exist on the contribution of a roller pump-assisted (RPA) cardiotomy suction unit to hemolysis. Elevation of free hemoglobin (fHb) following air suction (AS) or suction tip occlusion (STO) events of a pump-assisted cardiotomy suction unit was investigated in a mock circuit filled with blood from slaughtered domestic pigs. AS-associated hemolysis was measured over 240 minutes with 2 minutes of AS occurring every 10 minutes. STO-associated hemolysis was analyzed over 80-minute periods: configuration 1 (c1) comprised a cycle of 20 minutes (min) occlusion and 60 minutes RPA flow (20/60 minutes); c2 comprised 20 cycles of 1/3 minutes; c3 comprised 40 cycles of 0.5/1.5 minutes; and c4 comprised 80 cycles of 0.25/0.75 minutes. The AS setup did not lead to significant hemolysis after 2 (P = .97), 3 (P = .40) or 4 (P = .11) hours. The STO setup showed the greatest hemolysis (ΔfHb of 30 mg/dL) in c1 after 20 minutes. ΔfHb was different in c1 from all other configurations at 20 minutes (P < .0001) and 80 minutes (P < .05). Ex vivo generation of large negative pressures by STO events is the main cause of cardiotomy suction-associated hemolysis. The clinical relevance of this mechanism needs further investigations.
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Affiliation(s)
- Silje Ekroll Jahren
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hansjoerg Jenni
- Department for Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yannick Roesch
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rafael Arn
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Shade BC, Melchior RW, Fisher DR, High R, Mascio CE, Rosenthal TM, Holt DW. Comparison of three infant venous reservoirs with vacuum-assisted venous drainage during varying levels of cardiotomy suction. Perfusion 2019; 35:26-31. [PMID: 31146643 DOI: 10.1177/0267659119850344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vacuum-assisted venous drainage has gained widespread use within the pediatric perfusion community for use during cardiopulmonary bypass. It is questioned whether its efficiency may be compromised with application of excessive cardiotomy suction to the infant hard-shell venous reservoir. An in vitro simulation circuit was used to research this phenomenon. A comparison of three different infant hard-shell venous reservoirs also took place to determine if one reservoir type was more advantageous when handling cardiotomy suction. The reservoirs tested were the Maquet VHK 11000, Medtronic Affinity Pixie, and Terumo Capiox FX05. METHODS The in vitro simulation circuit consisted of a 1 L reservoir bag that was cannulated at one access point with an Edwards Lifesciences 10Fr aortic cannula and the other access area with an Edwards Lifesciences 10Fr right angle venous cannula and 12Fr right angle venous cannula that were joined together. Key points of measurement and response variables were the pressures on the connection of the venous cannulas, inlet of the venous reservoir, and flow through the venous line. Vacuum was applied and manipulated with a Maquet VAVD Controller to settings of -20 mmHg, -30 mmHg, -40 mmHg, -50 mmHg, and -60 mmHg. Cardiotomy suction was added at settings of 1 LPM, 2 LPM, 3 LPM, and 4 LPM. Values from each response variable were monitored and recorded. These data were utilized to compare the reservoirs with a random coefficient model for each response variable. CONCLUSIONS There is an adverse effect of excessive cardiotomy suction on the efficacy of vacuum-assisted venous drainage in infant hard-shell venous reservoirs. There is no significant difference between the VHK 11000, Pixie, and FX05 regarding their ability to handle this occurrence. An important discovery was that the FX05 showed a greater transfer of vacuum to the venous cannulas and reservoir inlet.
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Affiliation(s)
- Brandon C Shade
- Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard W Melchior
- Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas R Fisher
- Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robin High
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher E Mascio
- Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tami M Rosenthal
- Department of Perfusion Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David W Holt
- Division of Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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Abstract
BACKGROUND The major source of hemolysis during cardiopulmonary bypass (CPB) remains the cardiotomy suction.1 Previous research has shown that the combination of negative pressures and the massive air-blood interface exponentially increases hemolysis in suctioned blood. OBJECTIVE This research aims to decrease hemolysis by eliminating the air-to-blood interface by implementing the Venturi effect to create powerful suction. This research effort hypothesizes that the Venturi suction will result in less hemolysis, indicated by lower plasma free hemoglobin levels (PFH) compared to current vacuum suction. METHOD The research hypothesizes that a paradigm approach to cardiotomy suction that utilizes the Venturi effect with shorter tubing lengths and weighted sucker tips will further reduce hemolysis. RESULTS The vacuum-suctioned blood showed PFH levels significantly increased from baseline levels (p=0.0039). Neither the Venturi nor paradigm groups showed PFH levels significantly increased from baseline levels (p=0.0625 and p=0.125, respectively). There was a significant difference in PFH levels among the three conditions (p<0.0001). The vacuum condition showed significantly higher levels of PFH compared to both the Venturi and the paradigm conditions (p<0.001 for both). There was no significant difference in the PFH levels between the Venturi and the paradigm groups (p=1.00). CONCLUSION This study concludes that vacuum suction causes excessive hemolysis. A Venturi-powered suction system does not cause hemolysis and can be employed to reduce the damaging effects of vacuum suction on blood.
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Affiliation(s)
- Jared Arensdorf
- College of Allied Health Professions, Clinical Perfusion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Halle Petitt
- College of Allied Health Professions, Clinical Perfusion, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Holt
- College of Allied Health Professions, Clinical Perfusion, University of Nebraska Medical Center, Omaha, NE, USA
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Wiefferink AE, Weerwind PW, van Heerde W, Teerenstra S, Noyez L, de Pauw BE, Brouwer RM. Autotransfusion management during and after cardiopulmonary bypass alters fibrin degradation and transfusion requirements. J Extra Corpor Technol 2007; 39:66-70. [PMID: 17672185 PMCID: PMC4680668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED The coagulation-fibrinolytic profile during cardiopulmonary bypass (CPB) has been widely documented. However, less information is available on the possible persistence of these alterations when autotransfusion is used in management of perioperative blood loss. This study was designed to explore the influence of autotransfusion management on intravascular fibrin degradation and postoperative transfusions. Thirty patients, undergoing elective primary isolated coronary bypass grafting, were randomly allocated either to a control group (group A; n=15) or an intervention group (group B; n=15) in which mediastinal and residual CPB blood was collected and processed by a continuous autotransfusion system before re-infusion. Intravascular fibrin degradation as indicated by D-dimer generation was measured at five specific intervals and corrected for hemodilution. In addition, chest tube drainage and need for homologous blood were monitored. D-dimer generation increased significantly during CPB in group A, from 312 to 633 vs. 291 to 356 ng/mL in group B (p = .001). The unprocessed residual blood (group A) revealed an unequivocal D-dimer elevation, 4131 +/- 1063 vs. 279 +/- 103 ng/mL for the processed residual in group B (p < .001). Consequently, in the first post-CPB period, the intravascular fibrin degradation was significantly elevated in group A compared with group B (p = .001). Twenty hours postoperatively, no significant difference in D-dimer levels was detected between both groups. However, a significant intra-group D-dimer elevation pre- vs. postoperative was noticed from 312 to 828 ng/mL in group A and from 291 to 588 ng/mL in group B (p < .01 for both). Postoperative chest tube drainage was higher in the patients from group A, which also had the highest postoperative D-dimer levels. Patients in group A perceived a higher need for transfusions of red cells suspensions postoperatively. These data clearly indicate that autotransfusion management during and after CPB suppresses early postoperative fibrin degradation. KEYWORDS cardiopulmonary bypass, cardiotomy suction, coronary surgery, autotransfusion, fibrin degradation.
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Affiliation(s)
- Alice E.C.M. Wiefferink
- Department of Extra-Corporeal Circulation, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Patrick W. Weerwind
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Waander van Heerde
- Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Luc Noyez
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ben E. de Pauw
- Department of Bloodtransfusion and Transplantation Immunology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - René M.H.J. Brouwer
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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