Objective To introduce a novel approach using parallel placement of another oxygenator in the recirculation line as oxygen supply for oxygenator failure without circulatory arrest in cardiopulmonary bypass （CPB），and confirm its outcomes in an animal experiment. Methods A traditional piglet CPB model was established. Oxygenator failure model was established by reducing fraction of inspired oxygen （FiO2） from 80% to 21% after aortic cross-clamp and cardiac arrest in CPB. Another oxygenator was then parallel placed in the recirculation line to supply 100% oxygen.Dynamic changes in partial pressure of oxygen （PaO2），mixed venous oxygen saturation （SvO2），arterial oxygen saturation（SaO2） and blood pH of blood samples from the arterial perfusion duct were monitored with different blood flow of400 ml/min，800 ml/min and 1 100 ml/min. Results When FiO2 was reduced to 21%，PaO2 decreased to 64-67 mm Hg（P＜0.001），SaO2 decreased significantly to 88%-90% （P＜0.001），SvO2 decreased to 69%-72% （P＜0.001），and blood pH decreased too，all indicating oxygenator failure. After parallel placement of another oxygenator in the recirculation line was performed，PaO2，SaO2 and SvO2 all significantly increased，as well as blood pH. When the blood flow in the recirculation line achieved 33% or above of overall arterial perfusion flow，clinical oxygen demand was generally satisfied. Conclusion Parallel placement of another oxygenator in the recirculation line may be utilized as a treatment strategy for oxygenator failure without circulatory arrest and changeover of failed oxygenator.
Citation：
SupplyGUAN Yulong,WAN Caihong,FU Zhida,SUN Peng,LIANG Bixia,WANG Qian,LONG Cun.. A Pilot Animal Experiment on Oxygenator Failure with Parallel Placement of Another Oxygenator as Oxygen SupplyGUAN Yu-long1，WAN Cai-hong2，FU Zhi-da1，SUN Peng1，LIANG Bi-xia1，WANG Qian1，LONG Cun1.. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 329-333. doi: 10.7507/1007-4848.20130098
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Soo A， Booth K， Parissis H. Successful management of membrane oxygenator failure during cardiopulmonary bypass—the importance of safety algorithm and simulation drills. J Extra Corpor Technol， 2012， 44 （2）：78-80.
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| 2. |
de Almeida CE， Carraretto AR， Curi EF， et al. Malfunction of the extracorporeal circulation system：case report. Rev Bras Anestesiol， 2011， 61 （6）：777-785.
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Gautam NK， Schmitz ML， Zabala LM， et al. Anesthetic vaporizer mount malfunction resulting in oxygenation failure after initiating cardiopulmonary bypass：specific recommendations for the pre-bypass checklist. J Extra Corpor Technol， 2009， 41 （3）：183-186.
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Mejak BL， Stammers A， Rauch E， et al. A retrospective study on perfusion incidents and safety devices. Perfusion， 2000， 15 （1）：51-61.
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Fisher AR. The incidence and cause of emergency oxygenator changeovers. Perfusion， 1999， 14 （3）：207-212.
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Groom RC， Forest RJ， Cormack JE， et al. Parallel replacement of the oxygenator that is not transferring oxygen：the PRONTO procedure. Perfusion， 2002， 17 （6）：447-450.
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杨璟， 龚庆成. 氧合器氧合不良处理经验. 中国体外循环杂志， 2003， 1 （4）：241-243.
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Jirschik M， Keyl C， Beyersdorf F. A clinical comparison of bubble elimination in Quadrox and Polystan oxygenators. Perfusion， 2009， 24 （6）：423-427.
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De Somer F. Impact of oxygenator characteristics on its capability to remove gaseous microemboli. J Extra Corpor Technol， 2007， 39 （4）：271-273.
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Kelting T. Commentary on：Air bubble detector placement in the CPB circuit：a 2011 cross-sectional analysis of the practice of Certified Clinical Perfusionists. Perfusion， 2012， 27 （4）：352.
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Stehouwer MC， Boers C， de Vroege R， et al. Clinical evaluation of the air removal characteristics of an oxygenator with integrated arterial filter in a minimized extracorporeal circuit. Int J Artif Organs， 2011， 34 （4）：374-382.
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张忠新， 李福义， 闫志勇. 开心手术体外循环11例意外情况处理体会. 辽宁医学杂志， 1999， 13 （5）：243-244. 13 Guan YL， Wan CH， Wang SG， et al. Balanced ultrafiltration： inflammatory mediator removal capacity. Artif Organs， 2012， 36 （10）：894-900.
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王茜， 刘四华， 杨浩， 等. 猪主动脉手术选择性脑灌注期间脑血流的变化. 中华胸心血管外科杂志， 2012， 28 （3）：161-164.
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管玉龙， 郭建涛， 万彩红， 等. 平衡超滤能否有效滤除炎性介质. 中国体外循环杂志， 2011， 9 （4）：243-248.
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Clark JB， Guan YL， Mccoach R， et al. An investigational study of minimum rotational pump speed to avoid retrograde flow in three centrifugal blood pumps in a pediatric extracorporeal Life support model. Perfusion， 2011， 26 （3）：185-190.
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Klamt JG， Nabarro PR， Vicente WV， et al. SjO2 / SvO2 correlation during pediatric cardiac surgery with cardiopulmonary bypass. Rev Bras Cir Cardiovasc， 2011， 26 （4）：597-603.
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Lequeux PY， Bouckaert Y， Sekkat H， et al. Continuous mixed venous and central venous oxygen saturation in cardiac surgery with cardiopulmonary bypass. Eur J Anaesthesiol， 2010， 27 （3）：295-299.
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- 1. Soo A， Booth K， Parissis H. Successful management of membrane oxygenator failure during cardiopulmonary bypass—the importance of safety algorithm and simulation drills. J Extra Corpor Technol， 2012， 44 （2）：78-80.
- 2. de Almeida CE， Carraretto AR， Curi EF， et al. Malfunction of the extracorporeal circulation system：case report. Rev Bras Anestesiol， 2011， 61 （6）：777-785.
- 3. Gautam NK， Schmitz ML， Zabala LM， et al. Anesthetic vaporizer mount malfunction resulting in oxygenation failure after initiating cardiopulmonary bypass：specific recommendations for the pre-bypass checklist. J Extra Corpor Technol， 2009， 41 （3）：183-186.
- 4. Mejak BL， Stammers A， Rauch E， et al. A retrospective study on perfusion incidents and safety devices. Perfusion， 2000， 15 （1）：51-61.
- 5. Fisher AR. The incidence and cause of emergency oxygenator changeovers. Perfusion， 1999， 14 （3）：207-212.
- 6. Groom RC， Forest RJ， Cormack JE， et al. Parallel replacement of the oxygenator that is not transferring oxygen：the PRONTO procedure. Perfusion， 2002， 17 （6）：447-450.
- 7. 杨璟， 龚庆成. 氧合器氧合不良处理经验. 中国体外循环杂志， 2003， 1 （4）：241-243.
- 8. Jirschik M， Keyl C， Beyersdorf F. A clinical comparison of bubble elimination in Quadrox and Polystan oxygenators. Perfusion， 2009， 24 （6）：423-427.
- 9. De Somer F. Impact of oxygenator characteristics on its capability to remove gaseous microemboli. J Extra Corpor Technol， 2007， 39 （4）：271-273.
- 10. Kelting T. Commentary on：Air bubble detector placement in the CPB circuit：a 2011 cross-sectional analysis of the practice of Certified Clinical Perfusionists. Perfusion， 2012， 27 （4）：352.
- 11. Stehouwer MC， Boers C， de Vroege R， et al. Clinical evaluation of the air removal characteristics of an oxygenator with integrated arterial filter in a minimized extracorporeal circuit. Int J Artif Organs， 2011， 34 （4）：374-382.
- 12. 张忠新， 李福义， 闫志勇. 开心手术体外循环11例意外情况处理体会. 辽宁医学杂志， 1999， 13 （5）：243-244. 13 Guan YL， Wan CH， Wang SG， et al. Balanced ultrafiltration： inflammatory mediator removal capacity. Artif Organs， 2012， 36 （10）：894-900.
- 13. 王茜， 刘四华， 杨浩， 等. 猪主动脉手术选择性脑灌注期间脑血流的变化. 中华胸心血管外科杂志， 2012， 28 （3）：161-164.
- 14. 管玉龙， 郭建涛， 万彩红， 等. 平衡超滤能否有效滤除炎性介质. 中国体外循环杂志， 2011， 9 （4）：243-248.
- 15. Clark JB， Guan YL， Mccoach R， et al. An investigational study of minimum rotational pump speed to avoid retrograde flow in three centrifugal blood pumps in a pediatric extracorporeal Life support model. Perfusion， 2011， 26 （3）：185-190.
- 16. Klamt JG， Nabarro PR， Vicente WV， et al. SjO2 / SvO2 correlation during pediatric cardiac surgery with cardiopulmonary bypass. Rev Bras Cir Cardiovasc， 2011， 26 （4）：597-603.
- 17. Lequeux PY， Bouckaert Y， Sekkat H， et al. Continuous mixed venous and central venous oxygen saturation in cardiac surgery with cardiopulmonary bypass. Eur J Anaesthesiol， 2010， 27 （3）：295-299.
