Abstract

Objective

Our hospital has Terumo Fx05 and Fx15 oxygenators. The Fx05 provides a flow of 0-1200 mL/min, while the Fx15 can provide 1500-4000 mL/min. For patients requiring a cardiopulmonary bypass flow of 1200-1500 mL/min, we previously had to use either the Fx05 or Fx15 oxygenators. Recently, we started using the Euroset trilly oxygenator, which provides a flow of 500-3500 mL/min, suitable for these patients. However, there is insufficient data in the literature on the efficacy and safety of the Euroset Trilly compared to Terumo oxygenators

Materials and Methods

Our study aims to compare the efficacy, mortality, and clinical outcomes of Terumo Fx15 and Euroset Trilly oxygenators. Conducted at University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital’s Pediatric Cardiac Surgery Clinic, the study involved 40 patients (10-25 kg) who underwent atrial septal defect (ASD) or ventricular septal defect (VSD) closure surgery using either the Terumo FX15 or Euroset Trilly oxygenators.

Results

Between 03.03.2022 and 02.05.2024, we retrospectively analyzed 40 patients: 20 used the FX15 oxygenator (Group 1) and 20 used the Trilly oxygenator (Group 2). The average age was 53.65±23.075 days, average weight was 18.53±12.641 grams, and average BSA was 0.70±0.116.55% of patients were female. ASD closure was performed in 29 patients (72.5%), and VSD closure in 11 patients (27.5%).

Conclusion

Cardiopulmonary bypass surgeries rely on oxygenators to oxygenate the blood. This study compared the clinical performance of the Terumo FX15 and Euroset Trilly oxygenators. Retrospective data analysis of 40 patients revealed comprehensive effects on preoperative, operative, and postoperative parameters.

References

Starr MC, Boohaker L, Eldredge LC, et al. Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks’ Gestation. Am J Perinatol. 2020;37:341-8.

Askenazi D, Patil NR, Ambalavanan N, et al. Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants. Pediatr Nephrol. 2015;30:1511-8.

Jetton JG, Boohaker LJ, Sethi SK, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health. 2017;1:184-94.

Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res. 2011;69:354-8.

Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69:184-9.

Grigoryev DN, Liu M, Hassoun HT, Cheadle C, Barnes KC, Rabb H. The local and systemic inflammatory transcriptome after acute kidney injury. J Am Soc Nephrol. 2008;19:547-58.

Dodd-o JM, Hristopoulos M, Scharfstein D, et al. Interactive effects of mechanical ventilation and kidney health on lung function in an in vivo mouse model. Am J Physiol Lung Cell Mol Physiol. 2009;296:L3-11.

Hassoun HT, Lie ML, Grigoryev DN, Liu M, Tuder RM, Rabb H. Kidney ischemia-reperfusion injury induces caspase-dependent pulmonary apoptosis. Am J Physiol Renal Physiol. 2009;297:F125-37.

Hoke TS, Douglas IS, Klein CL, et al. Acute renal failure after bilateral nephrectomy is associated with cytokine-mediated pulmonary injury. J Am Soc Nephrol. 2007;18:155-64.

Basu RK, Wheeler DS. Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol. 2013;28:2239-48.

Doi K, Ishizu T, Fujita T, Noiri E. Lung injury following acute kidney injury: kidney-lung crosstalk. Clin Exp Nephrol. 2011;15:464-70.

Husain-Syed F, Slutsky AS, Ronco C. Lung-Kidney Cross-Talk in the Critically Ill Patient. Am J Respir Crit Care Med. 2016;194:402-14.

Chen D, Jiang L, Li J, et al. Interaction of Acute Respiratory Failure and Acute Kidney Injury on in-Hospital Mortality of Patients with Acute Exacerbation COPD. Int J Chron Obstruct Pulmon Dis. 2021;16:3309-16.

Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179-84.

Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. J Pediatr. 2018;197:300-8.

Li X, Yuan F, Zhou L. Organ Crosstalk in Acute Kidney Injury: Evidence and Mechanisms. J Clin Med. 2022;11:6637.

Starr MC, Schmicker RH, Halloran BA, et al. Premature infants born <28 weeks with acute kidney injury have increased bronchopulmonary dysplasia rates. Pediatr Res. 2023;94:676-82.

Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol. 2013;28:661-6.

Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46:1038-48.

Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol. 2003;14:1022-30.

Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure. Nephrol Dial Transplant. 1996;11:293-9.

Endre ZH. Renal ischemic preconditioning: finally some good news for prevention of acute kidney injury. Kidney Int. 2011;80:796-8.

Zimmerman RF, Ezeanuna PU, Kane JC, et al. Ischemic preconditioning at a remote site prevents acute kidney injury in patients following cardiac surgery. Kidney Int. 2011;80:861–7.

Venugopal V, Laing CM, Ludman A, Yellon DM, Hausenloy D. Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery: a secondary analysis of 2 small randomized trials. Am J Kidney Dis. 2010;56:1043-9.

Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126:443-56.

Rocha G, Ribeiro O, Guimarães H. Fluid and electrolyte balance during the first week of life and risk of bronchopulmonary dysplasia in the preterm neonate. Clinics (Sao Paulo). 2010;65:663-74.

Lorenz JM, Kleinman LI, Kotagal UR, Reller MD. Water balance in very low-birth-weight infants: relationship to water and sodium intake and effect on outcome. J Pediatr. 1982;101:423-32.

Bell EF, Warburton D, Stonestreet BS, Oh W. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med. 1980;302:598-604.

Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13:253-8.

Santschi M, Jouvet P, Leclerc F, et al. Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med. 2010;11:681-9.

Oh W, Poindexter BB, Perritt R, et al. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr. 2005;147:786-90.

Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2014;2014:CD000503.

Domenech P, Perez T, Saldarini A, Uad P, Musso CG. Kidney-lung pathophysiological crosstalk: its characteristics and importance. Int Urol Nephrol. 2017;49:1211-5.

Joannidis M, Forni LG, Klein SJ, et al. Lung-kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup. Intensive Care Med. 2020;46:654-72.

Barakat MF, McDonald HI, Collier TJ, Smeeth L, Nitsch D, Quint JK. Acute kidney injury in stable COPD and at exacerbation. Int J Chron Obstruct Pulmon Dis. 2015;10:2067-77.

Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med. 1995;155:1505-11.

van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Crit Care. 2013;17:R98.

Li X, Hassoun HT, Santora R, Rabb H. Organ crosstalk: the role of the kidney. Curr Opin Crit Care. 2009;15:481-7.

Evaluation of Oxygenators Used in Pediatric Cardiac Surgery

Abstract

References