title: A randomised controlled trial of roller versus centrifugal cardiopulmonary bypass pumps in patients undergoing pulmonary endarterectomy.
abstract: OBJECTIVE
  There is some controversy as to whether there is a benefit from the use of a centrifugal pump compared with a roller pump during cardiopulmonary bypass to facilitate cardiac surgery. We compared the two pumps, with the primary aim of determining any difference in the effects on inflammation after pulmonary endarterectomy surgery which required prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest.
  
  
  METHODS
  Between September 2010 and July 2013, 58 elective patients undergoing pulmonary endarterectomy were included in this prospective, randomised, controlled study; 30 patients were randomly allocated to the control group, which used a roller pump, and 28 patients to the treatment group, which used a centrifugal pump. Interleukin-6, procalcitonin, C-reactive protein, thromboelastographic parameters, P-selectin, international normalised ratio, activated prothrombin time, free haemoglobin, haematocrit, red blood cell count, white blood cell count, platelet count and protein S100β were recorded during and after the procedure. We also recorded the length of intensive care unit stay, blood loss and transfusion, neurological outcomes and respiratory and renal failure.
  
  
  RESULTS
  There was a significant difference in the primary outcome measure: Interleukin-6 was significantly higher in the roller pump group (587 ± 38 ng · l(-1) vs. 327 ± 37 ng · l(-1); p<0.001) 24 hours after surgery, which we interpreted as an increased inflammatory response. This was confirmed by a significant rise in the procalcitonin level in the roller pump group 48 hours following surgery (0.79 (0.08-25.25) ng · ml(-1) vs. 0.36 (0.02-5.83) ng · ml(-1); p<0.05). There were, however, no significant differences in clinical outcome data.
  
  
  CONCLUSIONS
  We have shown that the use of a centrifugal pump during prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with a reduced inflammatory response compared to the standard roller pump. Larger multi-centre trials in this area of practice are required.
authors.affiliation: Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, The Czech Republic.
authors.forename: F
authors.initials: F
authors.lastname: Mlejnsky
authors.affiliation: Department of Anaesthesia, Papworth Hospital, Cambridge, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Klein
authors.affiliation: Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, The Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Lindner
authors.affiliation: Department of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, The Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Maruna
authors.affiliation: Institute for Medical Biochemistry and Laboratory Diagnostics - The Centre for Thrombosis and Haemostasis, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Kvasnicka
authors.affiliation: Institute for Medical Biochemistry and Laboratory Diagnostics - The Centre for Thrombosis and Haemostasis, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Kvasnicka
authors.affiliation: Institute for Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Zima
authors.affiliation: Technology Centre ASCR, Prague, The Czech Republic.
authors.forename: O
authors.initials: O
authors.lastname: Pecha
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Lips
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Rulisek
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Porizka
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Kopecky
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, The Czech Republic jkunstyr@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Kunstyr
mesh_terms: D000328:Adult; D001798:Blood Proteins / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged
chemical_list: D001798:Blood Proteins
keywords: cardiac surgical procedure; cardiopulmonary bypass; centrifugal pump; inflammatory mediators; pulmonary endarterectomy; roller pump