The Effect of Pulsatile and Non-Pulsatile Extra Corporeal Perfusion on Cerebral Oxygen Saturation in Cardiopulmonary Bypass Patients

Year 2019, Volume: 7 Issue: 3, 180 - 187, 18.12.2019

Ayhan Şahin , İlker Yıldırım Onur Baran , Mustafa Günkaya Cavidan Arar , Ercan Güneri

Abstract

Objective: The flow type generated by a heart-lung machine is important in cardiopulmonary bypass. The use of pulsatile flow versus non-pulsatile flow during cardiopulmonary bypass has been a controversy among clinicians. We compared the effect of non-pulsatile and pulsatile flow during cardiopulmonary bypass on cerebral oxygenation. 

Method: We conducted a retrospective study of 50 adult patients who underwent coronary artery bypass graft surgery at our university hospital, with near infrared spectroscopy used to compare differences in cerebral oxygenation between the pulsatile and non-pulsatile flow type.

Result: There was no difference between the effect of pulsatile and non-pulsatile flow on the saturation of hemoglobin (SpO2), nor on the partial pressure of oxygen (pO2) and carbon dioxide (pCO2). The near infrared spectroscopy results were not different between the two flow types. 

Conclusion: There was no effect of the flow type generated by a heart-lung machine (pulsatile or non-pulsatile) on cerebral oxygenation in adult patients.

Keywords

pulsatile, cardiopulmonary bypass, perfusion

Kardiyopulmoner Bypass Hastalarında Pulsatil ve Pulsatil Olmayan Ekstra Korporeal Perfüzyonun Serebral Oksijen Satürasyonuna Etkisi

Abstract

Amaç: Kalp akciğer makinesi tarafından oluşturulan akım türü kardiyopulmoner bypassta önemlidir. Kardiyopulmoner bypass sırasında pulsatil akıma karşı pulsatil olmayan akımın kullanılması klinisyenler arasında bir tartışma konusu olmuştur. Kardiyopulmoner bypass sırasında pulsatil olmayan ve pulsatil akımın serebral oksijenasyon üzerindeki etkisini karşılaştırdık.

Yöntem: Üniversite hastanemizde koroner arter bypass greft cerrahisi yapılan 50 erişkin hastanın pulsatil ve pulsatil olmayan akım tipi arasındaki serebral oksijenasyon farklarını karşılaştırmak için kullanılan yakın kızılötesi spektroskopi ile retrospektif bir çalışma yaptık.

Bulgular: Pulsatil ve pulsatil olmayan akımın SpO2, pO2, pCO2 üzerindeki etkileri arasında anlamlı bir fark yoktu. Yakın Kızılötesi Spektroskopisi verilerinde her iki akım türü arasında anlamlı bir fark yoktu.

Sonuç: Erişkin hastalarda kalp-akciğer makinesi (pulsatil veya pulsatil olmayan) tarafından üretilen akım tipinin serebral oksijenasyona etkisi yoktu.

Keywords

pulsatil, kardiyopulmoner bypass, perfüzyon

References

• Ozturk S, Sacar M, Baltalarli A, Ozturk I. Effect of the type of cardiopulmonary bypass pump flow on postoperative cognitive function in patients undergoing isolated coronary artery surgery. Anatol J Cardiol. 2016; 16:875-880.
• Taylor KM, Bain WH, Davidson KG, Turner MA. Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients. Thorax. 1982; 37:324-330.
• Baraki H, Gohrbandt B, Del Bagno B, Haverich A, Boethig D, Kutschka I. Does pulsatile perfusion improve outcome after cardiac surgery? a propensity-matched analysis of 1959 patients. Perfusion. 2012; 27:166-174.
• Ji B, Undar A. An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and adult cardiac patients. ASAIO J. 2006; 52:357-361.
• Grubhofer G, Mares P, Rajek A, et al. Pulsatility does not change cerebral oxygenation during cardiopulmonary bypass. Acta Anaesthesiol Scand. 2000; 44:586-91.
• Tovedal T, Thelin S, Lennmyr F. Cerebral oxygen saturation during pulsatile and non-pulsatile cardiopulmonary bypass in patients with carotid stenosis. Perfusion. 2016; 31:72-77.
• O'Neil MP, Fleming JC, Badhwar A, Guo LR. Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects. Ann Thorac Surg. 2012; 94:2046-2053.
• Hori D, Nomura Y, Ono M, et al. Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. J Thorac Cardiovasc Surg. 2017; 154:1590-1598
• Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007; 104:51-58.
• ​Steppan J, Hogue CW, Jr. Cerebral and tissue oximetry. Best Pract Res Clin Anaesthesiol. 2014; 28:429-439.
• Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Brit J Anaesth. 2009; 103:i3-13.
• Toet MC, Lemmers PM. Brain monitoring in neonates. Early Hum Dev. 2009; 85:77-84.
• Morgan GE, Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's Clinical Anesthesiology, 5th Edition. 135: Lange. 2018; New York.
• Hickey PR, Buckley MJ, Philbin DM. Pulsatile and nonpulsatile cardiopulmonary bypass: review of a counterproductive controversy. Ann Thorac Surg. 1983; 36:720-737.
• Onorati F, Santarpino G, Presta P, et al. Pulsatile perfusion with intra-aortic balloon pumping ameliorates whole body response to cardiopulmonary bypass in the elderly. Crit Care Med. 2009; 37:902-911.
• Presta P, Onorati F, Fuiano L, et al. Can pulsatile cardiopulmonary bypass prevent perioperative renal dysfunction during myocardial revascularization in elderly patients? Nephron Clin Pract. 2009; 111:c229-235.
• Su XW, Guan Y, Barnes M, Clark JB, Myers JL, Undar A. Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass. Pediatr Res. 2011; 70:181-185.
• Undar A. The ABCs of research on pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass. Med Sci Monit. 2002; 8:ED21-24.
• Abramov D, Tamariz M, Serrick CI, et al. The influence of cardiopulmonary bypass flow characteristics on the clinical outcome of 1820 coronary bypass patients. Can J Cardiol. 2003; 19:237-243.
• Zhao J, Yang J, Liu J, et al. Effects of pulsatile and nonpulsatile perfusion on cerebral regional oxygen saturation and endothelin-1 in tetralogy of fallot infants. Artif Organs. 2011; 35:E54-58.
• Hökenek FGM, Bakuy V, Kavala Aycan A, et al. An evaluation of renal functions in pulsatile and non-pulsatile cardiopulmonary bypass in the elderly. Turk Gogus Kalp Dama. 2013; 21:610-615.
• ​Kim HK, Son HS, Fang YH, Park SY, Hwang CM, Sun K. The effects of pulsatile flow upon renal tissue perfusion during cardiopulmonary bypass: a comparative study of pulsatile and nonpulsatile flow. ASAIO J. 2005; 51:30-36.
• Poswal P, Mehta Y, Juneja R, Khanna S, Meharwal ZS, Trehan N. Comparative study of pulsatile and nonpulsatile flow during cardio-pulmonary bypass. Ann Card Anaesth. 2004; 7:44-50.