Regional cooling of blood in the extracorporeal circuit: New way of anticoagulation during CRRT
Authors:
Kroužecký Aleš 1; Sýkora Roman 1; Chvojka Jiří 1; Karvunidis Thomas 1; Raděj Jaroslav 1; Novák Ivan 1; Růžička Jiří 2; Beneš Jiří 2; Petránková Zuzana 2; Bolek Lukáš 2; Matějovič Martin 1
Authors‘ workplace:
JIP, I. interní klinika, Fakultní nemocnice Plzeň a Univerzita Karlova, Lékařská fakulta v Plzni
1; Ústav biofyziky, Univerzita Karlova, Lékařská fakulta v Plzni
2
Published in:
Anest. intenziv. Med., 20, 2009, č. 3, s. 143-148
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
To test the hypothesis that cooling of blood in the extracorporeal circuit of continuous veno-venous hemofiltration (CVVH) enables to realize the procedure without the need of anticoagulation.
Design:
Experimental animal study.
Methods:
We developed the device for selective cooling of extracorporeal circuit (20 °C) allowing blood rewarming (38 °C) just before returning into the body. 12 anesthetized and ventilated pigs were randomized to receive either 6 hrs of CVVH with application of this device (COOL; n = 6) or without it (CONTR; n = 6). Before the procedure and in 15., 60., 180., 360. minute after starting hemofiltration variables related to: 1) circuit patency (time to clotting [TC], number of alarm-triggered pump stopping [AS], venous and transmembranous circuit pressures [VP, TMP]); 2) coagulation status in the extracorporeal circuit (thrombin-antithrombin complexes [TATcirc], thromboelastography [TEG]) and 3) animal status (hemodynamics, hemolysis, biochemistry) were assessed.
Results:
The patency of all circuits treated with selective cooling was well maintained within the observation period. By contrast, 5 of 6 sessions were prematurely clotted in the untreated group. As a result, the number of AS was significantly higher in the CONTR group. In-circuit thrombus generation in CONTR group was associated with a markedly increasing TATcirc. TEG performed at 180.minute of the procedure revealed a tendency to a prolonged initial clotting time and a significant decrease in clotting rate of in-circuit blood in the COOL group. No signs of repeated cooling/rewarming-induced hemolysis were observed in animals treated with “hypothermic circuit” CVVH.
Conclusion:
In this porcine model, regional extracorporeal blood cooling proved effective in preventing in-circuit clotting without the need to use any other anticoagulant.
Keywords:
renal replacement therapy, anticoagulation, hypothermia, hemofiltration, cooling, critically ill
Sources
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2009 Issue 3
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