Influence of venous reservoir level on microbubbles in cardiopulmonary bypass

Abstract

Patients undergoing open-heart surgery may, post-operatively, suffer from neurological disorders due to microbubbles created during extracorporeal circulation. Venous air is not completely removed in open hard-shell venous reservoirs. We, therefore, investigated the relationship between venous reservoir blood level and the amount of microbubbles in different commercially available reservoirs for comparison and determination of safe level. An in vitro flow loop with a heart-lung machine was used to compare three different reservoirs (Maquet, Sorin and Medtronic) at different levels. Microbubbles were measured after the reservoir and after the arterial filter with a GAMPT BCC200 detector. Microbubble count and volume were significantly higher with decreasing reservoir level ( p = 0.014), but not as much as earlier studies have shown. Reducing the level from 1000 ml to 250 ml resulted in a 12.4% increase in bubble volume after the reservoir and 40.2% after the arterial filter. There was an almost linear trend towards more bubble volume with decreasing reservoir level (R2 = 0.98-0.83). There was a significant difference in microbubbles between the 3 tested reservoirs, up to 32.6%, p < 0.001 measured after the reservoir. Bubble volume from the Sorin reservoir was markedly lower after the arterial filter than from the Medtronic and Maquet reservoirs (up to 60 times p < 0.001). A lower reservoir level results in a moderate rise in microbubbles passing the reservoir. The minimum levels recommended by the manufacturers are safe. There was a significant difference in bubbles between the different reservoirs, especially after the arterial filter.