Heparin-coated circuit during cardiopulmonary bypass. A clinical study using closed circuit, centrifugal pump and reduced heparinization.
A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint-attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.5) participated in the study. Ten patients were randomized to be treated with heparin-coated equipment (CBAS) and reduced i.v. heparin (1.5 mg.kg-1) while 10 patients treated with identical but noncoated equipment and full heparinization (3 mg.kg-1) served in a Control group. A vacuum suction was used to collect the blood from the operating field and it was autotransfused at weaning from extracorporeal circulation (ECC). Blood samples were obtained from the venous (precircuit) and arterial (postcircuit) side. We used a new and very specific method for detection of C5a based on monoclonal antibodies. The concentration of C5a was low in both groups during the operation but a significant increase was seen on days 1 and 2. In the Control group there was an increase from 10.2 ng.ml-1 +/- 1.2 to 27.5 ng.ml-1 +/- 4.8 on day 2 and in the CBAS group from 10.7 ng.ml-1 +/- 1.2 to 35.6 ng.ml-1 +/- 11.6 on day 2 (NS between groups). The granulocytes and total leukocyte count increased at the end of ECC and was maintained at the elevated level throughout the study period. The amount of free haemoglobin was high in the autotransfused blood in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Sellevold
O F
OF
Department of Anaesthesia, University Hospital, University of Trondheim, Norway.
Berg
T M
TM
Rein
K A
KA
Levang
O W
OW
Iversen
O J
OJ
Bergh
K
K
D000328:Adult; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D003167:Complement Activation / Q000187:drug effects; D003182:Complement C5 / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005342:Fibrinolysis / Q000187:drug effects; D006324:Heart Arrest, Induced; D006461:Hemolysis / Q000187:drug effects; D006493:Heparin / Q000008:administration & dosage / Q000737:chemistry; D006801:Humans; D007275:Injections, Intravenous; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage
D003182:Complement C5; D011479:Protamines; D006493:Heparin