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Ann Thorac Surg 1997;63:1333-1339
© 1997 The Society of Thoracic Surgeons
Surgical Department A and Department of Clinical Engineering, the National Hospital, University of Oslo, Oslo; Department of Immunology and Transfusion Medicine, Nordland Central Hospital, Bodø, University of Tromsø, Tromsø; and Department of Immunology and Blood Bank, The Regional Hospital, University of Trondheim, Trondheim, Norway
Accepted for publication November 30, 1996.
Background. We studied whether negative inlet pressure created by a centrifugal pump during extracorporeal membrane oxygenation damages blood.
Methods. Fresh, whole human blood and primer were circulated through a test circuit, applying an inlet pressure of 0, -50, or -100 mm Hg. Thereafter, hemolysis and kidney function were compared between 6 patients treated before and 14 patients treated after inclusion in our setup of extracorporeal membrane oxygenation with a servo inlet pressure regulator.
Results. In vitro, negative inlet pressure caused substantial hemolysis, leukocyte and platelet destruction, and complement activation. Maximal plasma free hemoglobin concentrations were 199 mg/100 mL before use of the servo inlet pressure regulator and 40 mg/100 mL afterward (p = 0.06), and serum creatinine peaked at 330 and 115 µmol/L, respectively (p = 0.03). The minimal 24-hour diuresis normalized for weight was 4.8 mL/kg before use of the servo inlet pressure regulator and 45.6 mL/kg afterward (p = 0.03). Three of 5 evaluable patients before use of the servo inlet pressure regulator and 1 of 14 patients after inclusion in this setup experienced anuria (p = 0.04).
Conclusions. There were strong indications that reduction of negative pump inlet pressure with the servo regulator prevented hemolysis and kidney damage.
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