Japanese Journal of Extra-Corporeal Technology

We carried out a questionnaire about the incidents, accidents and safety of cardiopulmonary bypass and PCPS (include ECMO) in 2013, and we describe considerations about the current state of the safety control of cardiopulmonary bypass based on its questionnaire results.This questionnaire targeted the cardiopulmonary bypass use cases in both of 2011 and 2012 and its response rate was 76.6%. (423 of 552 establishments replied.)The 70,015 cases (35,015 of them in 2011 and 37,000 in 2012) used cardiopulmonary bypass during the period subject to the questionnaire. On the 1,323 cases of them, some events were occurred despite the levels of affects to the patients and its incidence was 1.8%.It is necessary to draw up checklists and double-check them for the risk management, and also it is important the proper method for using safety equipment.We need to turn to not only the accidents but also the incidents or potentially dangerous incidents and develop the strategies for them.We hope the questionnaire results will be taken advantage as the one of the consultations in order to prevent any incident and need to continue to take similar and further surveys in the future.

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Objective:In a cardiopulmonary bypass(CPB) procedure, a systemic inflammatory response is activated by contact of blood with an extracorporeal circuit during re-transfusion of pericardial suction blood(PSB). The aim of this study was to clarify activation of specific cytokines and the efficacy of PSB washing to attenuate inflammatory reactions during CPB.Methods:Blood samples were collected from 20 patients undergoing elective open-heart surgery using CPB at the time of aortic de-clamping. PSB was washed using an autologous blood recovery device(HVR-DUAL, Sorin Inc), then CBC, serum chemistry, Free-Hb, and IL-6 values were measured in circulating blood(V-group), PSB(K-group), and washed blood(S-group).Results: The value for serum IL-6 was 7.78 times higher in the K-group than the V-group (467±460 vs. 68±56 pg/mL, P< 0.01), while that was significantly decreased by the washing procedure(K-group vs. S-group: 467±460 vs. 51±60 pg/mL; P<0.01). In addition, the serum free Hb value was 3.69 times higher in the K-group than the V-group (0.21±0.12 vs. 0.06±0.04 g/dL;P<0.01) and was also significantly reduced by washing (K-group vs. S-group: 0.21±0.12 vs. 0.03±0.02 g/dL; P<0.01). Platelet count and Free-Hb were significant factors for increased serum IL-6 in PSB, and PSB washing resulted in a 68±16% reduction in platelet count.Conclusion: Serum IL-6 was markedly increased in PSB during CPB. PSB washing may be useful to attenuate cytokine activation caused by CPB.

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