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KMID : 0378019760190010072
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New Medical Journal
1976 Volume.19 No. 1 p.72 ~ p.76
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A Comparative Study of Three Different Models of Disposable Bubble Oxygenator
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Abstract
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The importance in open-heart surgery of full oxygenation of blood during cardiopulmonary bypass, with elimination of adequate amount of carbon dioxide without significant destruction, denaturation, or metabolic changes in the blood, together with the ability to lower or raise the blood temperatures in minimal time, is well recognized. The ideal oxygenator which would simulate the normal human lung in all of these aspects has not yet devised; however, the bubble oxygenator has stood the test of time and widespread usage for the limited intervals usually necessary for open-heart surgery. The clinical cases of fortytwo consecutive intracardiac operations under the cardiopulmonary bypass with disposable bubble oxygenator; Rygg-Kyvsgaard on 17 cases, Temptrol on 18 cases and Harvey on 7 cases, and American Optical roller pump during the period from August 1974 to May 1975 were reviewed to evaluate the ability of gas exchange and the blood trauma of the three different models of bubble oxygenator. In most cases the general tendency of arterial blood gas analyses performed on the blood samples taken during bypass was toward moderate respiratory alkalosis and mild metabolic acidosis. The respiratory component of the alterations were mainly the moderately lowered carbon dioxide tension and elevated oxygen tension in the blood during perfusion. This means that the oxygenation and carbon dioxide elimination by the oxygenator was too excessive than normal. These alterations were almost same in different models. It was suggested that the addition of small amounts of carbon dioxide to the oxygenator may be benificial to avoid these potentially dangerous respiratory imbalance during perfusion. In comparative studies of blood trauma produced by the oxygenator, the most useful indices appear to be rates of hemolysis and platelet loss. The rate of hemolysis was highest in the Harvey oxygenator group and lowest in Rygg-Kyvsgaard group. However, the plasma free hemoglobin has been well accepted physiologic range of 1 mg % per minute of cardiopulmonary bypass in all three groups. The platelet counts were decreased markedly along with bypass, especially in Rygg-Kyvsgaard group but there was no marked difference in platelet loss during perfusion between the three group. These alterations did not result in clinically related significant complications. In most cases the defoaming capacity and the heat exchanger efficiency were excellent. There was no death related to the bypass itself. All of these oxygenating units have been demonstrated to be satisfactory for general use in open heart surgery, and also seems that the significant difference-in the-clinical cardiopulmonary bypass with these different oxygenators were not observed.
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KEYWORD
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