Extracorporeal circulation can induce hypotension by both blood-material contact and pump-induced platelet aggregation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 120; no. 1; pp. 12 - 19
• Main Authors: Borgdorff, Piet, van den Bos, Gerard, Tangelder, Geert Jan
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-07-2000; AATS/WTSA; Elsevier
• Subjects: Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biocompatible Materials; Biological and medical sciences; Blood; Edema - etiology; Extracorporeal Circulation - adverse effects; Hypotension - etiology; Infusion Pumps; Male; Medical sciences; Platelet Aggregation; Rats; Rats, Wistar; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Lung disease; Edema; Pathophysiology; Rat; Respiratory disease; Treatment efficiency; Lung; Rodentia; Cardiovascular disease; Extracorporeal circuit; Aggregation; Cardiopulmonary bypass; Prevention; Vertebrata; Platelet; Mammalia; Treatment; Animal; Arterial hypotension; Risk factor; Complication; Technique
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1067/mtc.2000.105454

Objective: Use of extracorporeal systems in cardiopulmonary bypass and dialysis induces vascular reactions, which can lead to hypotension and lung edema. Methods: To study the contribution of blood-material contact and use of a roller pump, as well as prevention of their adverse effects, we perfused a rat hind leg with a tube connecting a carotid and a femoral artery. Results: Autoperfusion of an uncoated tube caused a fall of aortic pressure and femoral resistance to 66% ± 16% and 76% ± 15%, respectively, of their initial values within 2 hours, whereas in control animals without a shunt, these variables hardly changed (to 94% ± 2.8% and 99% ± 2.8%, respectively). Lung water content became significantly higher than that found in control animals (79.4% ± 1.50% versus 77.0% ± 1.67%). If we coated the tube with albumin, these changes were largely prevented. When the coated tube was placed in a roller pump, aortic pressure and femoral resistance immediately fell to 79% ± 17.2% and 63% ± 13.5%, respectively, whereas lung water content did not increase. The vasodilation was caused by platelet aggregation and could be prevented with aurintricarboxylic acid, which inhibits shear-induced platelet aggregation by blocking the binding of von Willebrand factor to platelet glycoprotein Ib receptors. Conclusions: Extracorporeal circulation may induce hypotension and lung edema by means of blood-material contact. Hypotension can be prevented by coating the system with albumin but can still result from pump-induced platelet aggregation. (J Thorac Cardiovasc Surg 2000;120:12-9)