Page 39 - ANZCP Gazette MAY 2014

AIR TRANSMISSION COMPARISON OF THE AFFINITY FUSION OXYGENATOR WITH INTEGRATED ARTERIAL FILTER TO THE AFFINITY NT OXYGENATOR WITH SEPARATED ARTERIAL FILTER−AN IN-VITRO STUDY
Kieron C. Potger, Darryl McMillan, Melissa Donnellan
Perfusion and Autotransfusion Unit, Dept. of Anaesthesia & Pain Management, Royal North Shore Hospital, Sydney, Australia
Background
A significant source of microemboli during cardiac surgery is the extracorporeal circuit (ECC). Arterial filters inserted in the ECC may minimise cerebral injury by capturing particulate matter and microbubbles. We clinically use the Affinity NT oxygenator with an Affinity arterial filter attached (‘Affinity system’). The new Affinity Fusion oxygenator (‘Fusion’) incorporates an integrated arterial filter. We wanted to determine if the Fusion was as safe as the Affinity system in terms of relative microbubble transmission of introduced air.
Methods
A recirculating in-vitro circuit was used to compare the two oxygenator-arterial filter systems (Fusion; Affinity system). Microbubbles were detected in the outflow line of the oxygenator-arterial filter. Measurements were taken during the first and third minutes after the commencement of bolusing 50 mls air or infusing 20 ml/min air while altering pump flow rates (3L/min; 5 L/min).
Results
Microbubble volume transmitted by the Fusion was less than the Affinity system at both pump flow rates whether during air bolus or air infusion. The Fusion cleared its air challenge at a greater rate than the Affinity system. Median bubble size transmitted by the Fusion oxygenator was consistently smaller than that of the Affinity system.
Conclusions
Under the parameters of this in-vitro study, the Affinity Fusion oxygenator with integrated arterial filter is as safe as the Affinity NT oxygenator with separated arterial filter in terms of microbubble handling. However, more research is needed to confirm this study’s findings and generalisability to the clinical environment.
CHALLENGES IN THE MANAGEMENT OF VA ECMO IN PATIENTS WITH COMPROMISED LUNG FUNCTION: WHAT IS THE IMPACT OF THE EJECTED BLOOD?
Summary
Extracorporeal membrane oxygenation can provide effective mechanical circulatory and respiratory support for failing circulation and / or respiratory function. The blood flow from
the native pathway (the ejected blood) could present additional challenges for the extracorporeal membrane oxygenation cannulation, support and management, and the impact on the coronary and cerebral perfusion. How well we assess, manage and estimate the effect of this impact.
Alexander Guecheff
MAY 2014 | www.anzcp.org
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