The rheological effects of X-Coating with albumin and hetastarch on blood during cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) exposes blood to artificial surfaces, resulting in mechanical damage to the formed elements of the blood. The purpose of this study was to examine the effect of poly(2-methoxyethylacrylate) coating (PMEA, X-Coating) on coagulation and inflammation under various prime conditions. An in vitro analysis was conducted utilizing fresh whole human blood (2 units) and a CPB circuit (n = 18) consisting of a venous reservoir, oxygenator, and arterial filter. Nine nontreated circuits were used in a control group (CTR) and an equal number of tip-to-tip PMEA circuits for treatment (TRT). Each group was divided into three subgroups based upon prime: crystalloid, hetastarch (6%), and albumin (5%). CPB was conducted with a hematocrit 30% +/- 2, temperature 37 degrees C +/- 1, and a flow of 4 L/min. Samples were collected at 0, 60, 120, and 240 minute intervals. Endpoint measurements included thromboelastograph index (TI), and markers of inflammation and coagulation. The TI was significantly depressed in both groups when hetastarch was used in the prime. The TRT had significantly higher TI levels in both the crystalloid (0.3 +/- 0.1 vs. -3.3 +/- -1.2, P < .05) and albumin (0.6 +/- 0.2 vs -3.9 +/- -1.1. P < .03) subgroups compared to CTR groups. Platelet count was significantly higher in TRT as compared to CTR groups, except for both hetastarch groups. SEM demonstrated significant fibrin deposition on nontreated circuitry but little to no detection in the TRT group. In conclusion, both surface coating and prime components significantly effect coagulation, with PMEA circuits resulting in more favorable preservation of function.
Nutter
Bernadette T
BT
Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska 68198-5155, USA. bnutter@unmc.edu
Stammers
Alfred H
AH
Schmer
Ryan G
RG
Ahlgren
Rebecca L
RL
Ellis
Tunisia A
TA
Gao
Chen
C
Holcomb
Hunter B
HB
Hock
Lynette
L
Burkeman
Tab
T
D000179:Acrylates; D000327:Adsorption / Q000187:drug effects; D000418:Albumins / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D066298:In Vitro Techniques; D007249:Inflammation; D013916:Thrombelastography
D000179:Acrylates; D000418:Albumins; D020099:Coated Materials, Biocompatible; D006895:Hydroxyethyl Starch Derivatives