Air, inflammation and biocompatibility of the extracorporeal circuits

The inflammatory response in cardiac surgery using extracorporeal circulation (ECC) has been widely discussed in the literature with analysis on cytokines released in humans; demonstrating manifold trigger causes. To mitigate this response—mainly linked to the contact and recognition by the blood of a “non-self” surface—many efforts have been made to make the circuits of the extra-corporeal circulation “biomimetics”; trying to emulate the cardio-vascular system. In other words, biomedical companies have developed many biocompatible products in order to reduce the invasiveness of the ECC. One of the techniques used to reduce the contact of blood with “nonself” surfaces is the “coating” of the internal surfaces of the ECC. This can be done with phospholipidic, electrically neutral, and heparin derivates with anticoagulant activity. The coating can be divided into two categories: the “passive coating” with Phosphorylcholine by biomedical companies and the administration of albumin added to the “priming” during the filling of the circuit by the perfusionist. Alternatively, we have the “active” coating: treatment of the internal surfaces in contact with the blood with neutral proteins and heparin. The latter are different according to the production company, but the aim is always to maintain high levels of systemic and local anticoagulation, inactivating the “contact” coagulation between the blood and the surfaces. A recent study demonstrates that the use of an “active coating” is associated with better preservation of the endothelial glycocalyx compared with “passive coating” circuits.

[1]  Markku Peltonen,et al.  Effect and safety of 4% albumin in the treatment of cardiac surgery patients: study protocol for the randomized, double-blind, clinical ALBICS (ALBumin In Cardiac Surgery) trial , 2020, Trials.

[2]  C. Boer,et al.  Microvascular Alterations During Cardiac Surgery Using a Heparin or Phosphorylcholine-Coated Circuit. , 2019, Journal of cardiothoracic and vascular anesthesia.

[3]  F. Bartolomucci,et al.  Fibonacci's Golden Ratio-An Innovative Approach to the Design and Management of Extra-Corporeal Circulation. , 2019, Surgical technology international.

[4]  J. Korchowiec,et al.  The role of DPPG in lung surfactant exposed to benzo[a]pyrene. , 2019, Environmental science. Processes & impacts.

[5]  R. Bartlett,et al.  Inflammatory Effects of Blood–Air Interface in a Porcine Cardiopulmonary Bypass Model , 2020, ASAIO journal.

[6]  T. Carrel,et al.  Minimally invasive extracorporeal circulation: excellent outcome and life expectancy after coronary artery bypass grafting surgery. , 2017, Swiss medical weekly.

[7]  J. Manďák,et al.  Effects of conventional CPB and mini-CPB on neutrophils CD162, CD166 and CD195 expression , 2017, Perfusion.

[8]  Shuvo Roy,et al.  Evolution of Gas Permeable Membranes for Extracorporeal Membrane Oxygenation , 2017, Artificial organs.

[9]  Y. Durandy Vacuum-assisted venous drainage, angel or demon: PRO? , 2013, The journal of extra-corporeal technology.

[10]  E. Storey,et al.  Carbon dioxide insufflation in open-chamber cardiac surgery: a double-blind, randomized clinical trial of neurocognitive effects. , 2012, The Journal of thoracic and cardiovascular surgery.

[11]  M. Cotrufo,et al.  Does Priming Implementation with Low-dose Albumin Reduce Postoperative Bleeding following Cardiopulmonary Bypass? , 2003, The International journal of artificial organs.