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Optimization of venous return tubing diameter for cardiopulmonary bypass


Ni, Yi-ming; Leskosek, Boris; Shi, Li-ping; Chen, Ying-lian; Qian, Lin-feng; Li, Ren-yuan; Tu, Zheng-liang; von Segesser, Ludwig K (2001). Optimization of venous return tubing diameter for cardiopulmonary bypass. European Journal of Cardio-Thoracic Surgery, 20(3):614-620.

Abstract

Objective: To determine the optimal venous tubing diameter for adult cardiopulmonary bypass (CPB) to improve gravity drainage and to reduce priming volume. Methods: (A) Maximum bovine blood flow rates by gravity drainage were assessed in vitro for four different tubing diameters (1/2, 3/8, 5/16,1/4 inch) with three different lengths and various pre- and afterloads. Based on the results of (A) and multiple regression analyses, we developed equations to predict tubing sizes as a function of target flows. (C) The equations obtained in (B) were validated by ex vivo bovine experiments. (D) The clinically required maximal flows were determined retrospectively by reviewing 119 perfusion records at Zurich University. (E) Based on our model (B), the clinical patient and hardware requirements, the optimal venous tubing diameter was calculated. (F) The optimized venous tubing was evaluated in a prospective clinical trial involving 312 patients in Hangzhou. Results: For a mean body surface area of 1.83±0.2 m2, the maximal perfusion flow rate (D) achieved with 1/2-inch (=1.27 cm2) venous tubing was 4.62±0.57 l/min (range: 2.50-6.24 l/min). Our validated model (B,C) predicted 1.0 cm2 as optimal cross-sectional area for the venous line. New tubing packs developed accordingly were used routinely thereafter. The maximal flow rate was 4.93±0.58 l/min (range: 3.9-7.0) in patients with a mean body surface area of 1.62±0.21 m2. Conclusion: The new venous tubing with 1.0-cm2 cross-sectional area improves the drainage in the vast majority of adult patients undergoing CPB and reduces the priming volume (−27 ml/m). Reduced hemodilution can prevent homologous transfusions if a predefined transfusion trigger level is not reached

Abstract

Objective: To determine the optimal venous tubing diameter for adult cardiopulmonary bypass (CPB) to improve gravity drainage and to reduce priming volume. Methods: (A) Maximum bovine blood flow rates by gravity drainage were assessed in vitro for four different tubing diameters (1/2, 3/8, 5/16,1/4 inch) with three different lengths and various pre- and afterloads. Based on the results of (A) and multiple regression analyses, we developed equations to predict tubing sizes as a function of target flows. (C) The equations obtained in (B) were validated by ex vivo bovine experiments. (D) The clinically required maximal flows were determined retrospectively by reviewing 119 perfusion records at Zurich University. (E) Based on our model (B), the clinical patient and hardware requirements, the optimal venous tubing diameter was calculated. (F) The optimized venous tubing was evaluated in a prospective clinical trial involving 312 patients in Hangzhou. Results: For a mean body surface area of 1.83±0.2 m2, the maximal perfusion flow rate (D) achieved with 1/2-inch (=1.27 cm2) venous tubing was 4.62±0.57 l/min (range: 2.50-6.24 l/min). Our validated model (B,C) predicted 1.0 cm2 as optimal cross-sectional area for the venous line. New tubing packs developed accordingly were used routinely thereafter. The maximal flow rate was 4.93±0.58 l/min (range: 3.9-7.0) in patients with a mean body surface area of 1.62±0.21 m2. Conclusion: The new venous tubing with 1.0-cm2 cross-sectional area improves the drainage in the vast majority of adult patients undergoing CPB and reduces the priming volume (−27 ml/m). Reduced hemodilution can prevent homologous transfusions if a predefined transfusion trigger level is not reached

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Item Type:Journal Article, refereed, original work
Communities & Collections:National licences > 142-005
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Pulmonary and Respiratory Medicine
Health Sciences > Cardiology and Cardiovascular Medicine
Language:English
Date:1 September 2001
Deposited On:25 Sep 2018 14:29
Last Modified:15 Apr 2021 14:51
Publisher:Oxford University Press
ISSN:1010-7940
OA Status:Hybrid
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/s1010-7940(01)00840-5

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