Münch F, Purbojo A, Cesnjevar R, Teske A (2019)
Publication Type: Journal article
Publication year: 2019
Book Volume: 28
Pages Range: 26-36
Journal Issue: 2
Extracorporeal circuits in CPB and ECMO/ ECLS represent a “necessary evil“ for ade-quately treating patients with a conforming diagnosis. The contact of blood to foreign surfaces, for instance the PVC tubing of CPB components, leads to pathophysiological reactions with corresponding and systemic negative effects for the patient. Foreign surface contact in the CPB circuit trigger, to a greater or lesser extent, an un-specific inflammatory response in the pa-tient. The release of highly active substances such as cytokines and complementary factors, intended for infection defense wit-wit-hout specific targets, can potentially cause damage to any organ. The resulting organ dysfunction is usually summarized under the term post-perfusion syndrome. The kidneys are very sensitive towards the pathophysiology of ECC. Even today postoperative acute kidney injury (AKI) remains a severe complication after cardiac surgery and is associated with high morbi-dity and mortality. It is indisputable that the altered hemodynamic of CPB has pathophysiological implications. Loss of pulsa-tile flow, inflammatory reactions, the pre-sence of free hemoglobin, hemolysis and vasoconstriction of the afferent glomerular arterioles with the resulting reduction of renal perfusion are part of the damaging me-chanism for both kidneys. These causes of AKI can be ameliorated with adequate cardiac output, normothermic perfusion and optimized fluid management [1]. As per-fusionists we often see the development of edema after ECC, especially in the lungs. Different modes of filtration and various filters are available to counteract interstitial edema. The use of ultrafiltration (UF), ze-ro-balance ultrafiltration (Z-BUF) and modified ultrafiltration (MUF) is associated with an improvement in pulmonary func-tion. The greatest benefits are seen in pediatric patients with the most striking mis-match between circuit size and body surface area [2]. It can be debated whether more in-ert materials in ECC circuits still require the use of hemofiltration or whether filters should be restricted in the ECC circuit after a risk-benefit analysis. From a techni-cal viewpoint the hemofilter is just additio-nal foreign surface area in the ECC circuit with consecutive pathophysiological reac-tions. A minimization of foreign surfaces as well as avoiding blood-air contact would reduce the number of damaging mediators released through blood-filter contact. In short, what is not released must not be eli-minated. However, our daily practice sees increasingly ill patients with multiple mor-bidities undergoing ECC or ECMO/ECLS, for whom we as perfusionists have to of-fer solutions to counteract ECC pathophysiology and disease-related dysfunctions. However, the elimination of immune-ac-tive mediators, thus diminishing their negative hout effects plays an important role. The use of adsorbers in ECC represents another promising, alternative for reducing or eli-minating damaging components dissolved in the blood plasma. In this article the me-chanisms of action as well as the applicabi-lity of hemofilters and adsorbents in daily use by perfusionists are presented and explained.
APA:
Münch, F., Purbojo, A., Cesnjevar, R., & Teske, A. (2019). Update on hemofiltration and hemoperfusion Update hämofiltration und hämoperfusion. Kardiotechnik, 28(2), 26-36.
MLA:
Münch, Frank, et al. "Update on hemofiltration and hemoperfusion Update hämofiltration und hämoperfusion." Kardiotechnik 28.2 (2019): 26-36.
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