SHA24/003004

Clinical review of New generation OF oxygenators with integrated arterial line filters

ABDULRAHMAN ALHARBI PRINCE SALMAN MILITARY HOSPITAL Tabuk,Saudi Arabia

• New generation of oxygenators with integrated arterial line filters have been marketed to improve the efficacy of cardiopulmonary bypass (CPB). • Differences: in designs, materials, coating surfaces, pore size of arterial filter, and static prime exist between the oxygenators.

Because microembolic events continue to plague complications associated with ECC, the call to advance filter technology is growing.

• Industry leaders continue to address these challenges with varied results, having introduced several innovations that either alter the configuration of common features or go beyond the theoretical principles guiding conventional filter designs.

most commercially available designs incorporate a large-volume chamber to decrease flow velocity and allow more time for any air bubbles to rise up and out of circulation through an appropriately located purge port.

• Additionally, the wetted pores of a micron screen interposed between the inlet and outlet of the filter are used to form a physical barrier to prevent the passage of bubbles and further enhance air separation.

In theory there are at least two ways that free gases in a liquid can pass through a wetted micropore, first by exceeding the bubble-point pressure (BPP) of the micropore itself or alternatively by crossing the screen barrier as dissolved gases.

Bubble-Point Pressure: The BPP can be defined as the amount of pressure required to eject air across a wetted pore and is described.

• Gas Diffusion in a Liquid • The amount and rate of gas diffusion into a liquid is dependent on the principles described by Henry’s law and Fick’s law of diffusion

Understanding micropore filters and the limitations they represent will help perfusionist to the significance of events such as air entry in the venous line, sampling manifold manipulations, reductions in venous reservoir level, or changes in gas solubility with changes in circulating blood temperature

• both are oxygenators with integrated arterial line filters and it was designed with a dedicated geometry aimed at making debubbling automatic. it does not need to be tapped or inverted to evacuate the air.

• The two groups showed similar baseline and intraoperative variables.

No differences were recorded in pressure drop and gas exchange during CPB & Heat Exchange

Don’t trust Brochures Both similar fluid balance

• Gas exchange • When the respiratory function was considered, both oxygenators proved to be highly effective in achieving adequate oxygenation good CO2• scavenging effect was demonstrated with both Oxygenators ‫مشوح الشمري‬

the Sorin Synthesis oxygenator has a microporous polypropylene membrane requiring a static prime of 430 mL with a surface of 2.0 m2, sustains up to 8 L/min of blood flow, and has a biocompatible coating with an integrated polyester arterial line filter of 40 mm pore size It need for total Prime with Heat Exchanger 500 ml

Difficult priming less than 40ml/min

• Gaseous microemboli GME which generated during CPB by perfusionist have been recognized as important contributing factors to embolic organ damage

• But Both integrated arterial filter with a special profile which makes debubbling automatic, assures an exceptional level of safety and practicality.

• The full transparency of the various components allows visual access to each single step of the blood path.

• The recirculation stopcock allows continuous purge with a low reduction in Arterial flow (150ml/min with flow of 4 l/min).

• A Luer connector is also available to measure the filter pressure.

Troubleshooting

Finally, miniaturization of the CPB machine has proved to be effective in reducing pump-priming, inflammation, blood loss, and donor blood usage.

Innovative CPB settings have been developed in order to integrate the above-mentioned concepts of “surface-coating,” “blood-filtration,” and “miniaturization.” Indeed, the integration of arterial line filters with oxygenators fulfill these principles.

TANK YOU ABDULRAHMAN ALHARBI PRINCE SALMAN MILITARY HOSPITAL Tabuk,Saudi Arabia ---------------------------------------------------------------• AFH2007@GMAIL.COM • @AL7ARBI85