NoBlood

Minimized closed circuit/centrifugal pump extracorporeal circulation: an effective aid in coronary bypass operations in Jehovah's Witnesses.

Just SS, Müller T, Albes JM.
Department of Cardiovascular Surgery, Heart-Center Brandenburg, Ladeburger Str. 17, 16321 Bernau, Germany.

Surgical treatment of a Jehovah's Witnesses continues to be a great challenge in cardiac surgery. Different strategies are used to minimize the risk for early mortality, prolonged intensive care unit stay and hospitalization, resulting from anemia. Minimized closed circuit extracorporeal circulations have been shown to reduce adverse effects of conventional CPB*. Two patients underwent urgent coronary revascularization for triple-vessel disease.

The miniECC** (Stöckert) is a phosphorylcholine-coated device which integrates the functions of oxygenation, filtration, and pumping in a compact manner with reduced total surface area and priming volume. After a well-tolerated operation the patients showed only minimal red blood cell damage (free hemoglobin 93 mg/l). Hematocrit levels decreasing perioperatively in both patients only moderately (32% and 30%).

In these two instances using miniECC we showed a markedly reduced blood cell damage and myocardial trauma. Furthermore, we observed hematocrit levels being higher as compared to standard CABG*** patients, providing an optimized startpoint for an uneventful postoperative course. MiniECC can be routinely employed and reduces red blood cell damage. Therefore, it can be an effective aid in CABG operations in Jehovah's Witnesses.

PMID: 17669788 [PubMed - in process]

Source: Minimized closed circuit/centrifugal pump extracor...[Interact Cardiovasc Thorac Surg. 2007] - PubMed Result

Notes for non-PhD non-english-spoken like me... :
* CardioPulmonary Bypass
** mini ExtraCorporeal Circuit
*** Coronary Artery By-Pass Graft

For those who don't work in Cardiac Surgery and may not understand. It must be kept in mind that "so called Mini Circuits" (which are a new twist on conventional condensed circuits) have drawbacks and are not embraced here in the USA and other places for many reasons. 1.They pass micro air faster and more easily than conventional condensed circuits and condensed circuits can be RAP'd for free obtaining the same goal of reduced hemodilution. 2. There is less reaction time for the Perfusionist who operates these circuits in the event of venous air which all circuits have routinely especially in more difficult cases. 3. They typically cost 2 to 3 times as much as a conventional condensed circuit which are the standard and have safely been around for years. 4. There are no concrete studies showing less blood damage, and what little blood damage and activation that may be seen in longer complex bypass case runs are transient and reversible in-vivo with patient blood levels returning to baseline within hours without morbidity. Below are a couple of important articles to read and understand this phenomenon.

Kurusz M, Butler BD. Bubbles and bypass: an update. Perfusion 2004;19 (Suppl 1):S49-S55.

Norman MJ, Sistino JJ, Acsell JR. The effectiveness of low-prime cardiopulmonary bypass circuits at removing gaseous emboli. J ExtraCorpor Technol. 2004;36(4):336-42.

Abdel-Rahman U, Ozaslan F, Risteski PS, Martens S, Moritz A, Al Daraghmeh A, et al. Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit? Ann Thorac Surg 2005 Jul;80(1):238-43.

Barak M, Katz Y. Microbubbles: pathophysiology and clinical implications. Chest 2005 Oct;128(4):2918-32.

Lilly KJ, O'Gara PJ, Treanor PR, Reardon D, Crowley R, Hunter C, Shapira OM, Aldea GS, Lazar HL, Shemin RJ. Cardiopulmonary bypass: it's not the size, it's how you use it! Review of a comprehensive blood-conservation strategy. J ExtraCorpor Technol. 2004;36(3):263-8.

Eising GP, Pfauder M, Niemeyer M, Tassani P, Schad H, Bauernschmitt R, et al. Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery? Ann Thorac Surg 2003 Jan;75(1):23-7.

Zelinka ES, Ryan P, McDonald J, Larson J. Retrograde autologous prime with shortened bypass circuits decreases blood transfusion in high-risk coronary artery surgery patients. J ExtraCorpor Technol. 2004;36(4):343-7.

__________________
Keith A. Samolyk CCP, LCP
Global Blood Resources LLC
P.O. Box 383 Somers CT. 06071
Tel (800) - 942 - 9243
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www.mybloodfirst.com

Thanks a lot for your precious contribute.

However, let me say that here, in the VERY old Europe, it's already a miracle that it exist somebody trying to operate without blood. If an obsolete method to do so works, it's always welcome.