Extracorporeal heparin adsorption following cardiopulmonary bypass with a heparin removal device - An alternative to protamine

Weike Tao, Donald J. Deyo, Robert L. Brunston, Roger A. Vertrees, Joseph B. Zwischenberger

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Objectives: To evaluate the therapeutic efficacy and applicability of a heparin removal device (HRD) based on plasma separation and poly-L-lysine (PLL) affinity adsorption as an alternative to protamine in reversing systemic heparinization following cardiopulmonary bypass (CPB). Design: A prospective study. Setting: University research laboratory. Subjects: Adult female swine (n = 7). Interventions: Female Yorkshire swine (n = 7, 67.3 ± 3.5 [SEM] kg) were subjected to 60 mins of right atrium-to-aortic, hypothermlc (28°C) CPB. After weaning from CPB, the right atrium was recannulated with a two-stage, dual-lumen cannula which was connected to an HRD via extracorporeal circulation. Blood flow was drained at 1431.2 ± 25.4 mL/min from the inferior vena cava, through the plasma separation chamber of the HRD (where heparin was bound to PLL), and reinfused into the right atrium. The HRD run time was determined by a previously established mathematical model of first-order exponential depletion. Measurements and Main Results: Heart rate, mean arterial pressure, pulmonary arterial pressure, central venous pressure, kaolin and celite activated clotting time (ACT), activated partial thromboplastin time (APTT), heparin concentration, and plasma free hemoglobin were obtained before, during, and after the use of the HRD. Pre-CPB ACT was 167 ± 89 secs (kaolin) and 99 ± 7 secs (celite), and APTT was 34 ± 5 secs. The HRD run time averaged 27.4 ± 1.5 mins targeted to remove 90% total body heparin. Use of the HRD was not associated with any adverse hemodynamic reactions or increases in plasma free hemoglobin. The heparin concentration immediately following CPB was 4.65 ± 0.24 units/mL, with ACT >1000 secs and APTr >150 secs in all animals. During heparin removal, total body heparin content followed first-order exponential depletion kinetics. At the end of the HRD run, heparin concentration decreased to 0.51 ± 0.09 units/mL, with kaolin ACT returning to 177 ± 22 secs, celite ACT returning to 179 ± 17 secs, and APTT returning to 27 ± 3 secs (p > .05 vs. pre-CPB baseline for all variables). Conclusions: The HRD is capable of reversal of anticoagulation following CPB without significant blood cell damage or changes In hemodynamics. The HRD, therefore, can serve as an alternative to achieve heparin clearance in clinical situations where use of protamine may be contraindicated.

    Original languageEnglish (US)
    Pages (from-to)1096-1102
    Number of pages7
    JournalCritical Care Medicine
    Volume26
    Issue number6
    DOIs
    StatePublished - 1998

    Fingerprint

    Device Removal
    Protamines
    Cardiopulmonary Bypass
    Adsorption
    Heparin
    Diatomaceous Earth
    Kaolin
    Partial Thromboplastin Time
    Heart Atria
    Lysine
    Arterial Pressure
    Hemoglobins
    Swine
    Hemodynamics

    Keywords

    • Cardiopulmonary bypass
    • Extracorporeal circulation
    • Heparin
    • Poly-L- lysine
    • Protamine
    • Swine

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Extracorporeal heparin adsorption following cardiopulmonary bypass with a heparin removal device - An alternative to protamine. / Tao, Weike; Deyo, Donald J.; Brunston, Robert L.; Vertrees, Roger A.; Zwischenberger, Joseph B.

    In: Critical Care Medicine, Vol. 26, No. 6, 1998, p. 1096-1102.

    Research output: Contribution to journalArticle

    Tao, Weike ; Deyo, Donald J. ; Brunston, Robert L. ; Vertrees, Roger A. ; Zwischenberger, Joseph B. / Extracorporeal heparin adsorption following cardiopulmonary bypass with a heparin removal device - An alternative to protamine. In: Critical Care Medicine. 1998 ; Vol. 26, No. 6. pp. 1096-1102.
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    abstract = "Objectives: To evaluate the therapeutic efficacy and applicability of a heparin removal device (HRD) based on plasma separation and poly-L-lysine (PLL) affinity adsorption as an alternative to protamine in reversing systemic heparinization following cardiopulmonary bypass (CPB). Design: A prospective study. Setting: University research laboratory. Subjects: Adult female swine (n = 7). Interventions: Female Yorkshire swine (n = 7, 67.3 ± 3.5 [SEM] kg) were subjected to 60 mins of right atrium-to-aortic, hypothermlc (28°C) CPB. After weaning from CPB, the right atrium was recannulated with a two-stage, dual-lumen cannula which was connected to an HRD via extracorporeal circulation. Blood flow was drained at 1431.2 ± 25.4 mL/min from the inferior vena cava, through the plasma separation chamber of the HRD (where heparin was bound to PLL), and reinfused into the right atrium. The HRD run time was determined by a previously established mathematical model of first-order exponential depletion. Measurements and Main Results: Heart rate, mean arterial pressure, pulmonary arterial pressure, central venous pressure, kaolin and celite activated clotting time (ACT), activated partial thromboplastin time (APTT), heparin concentration, and plasma free hemoglobin were obtained before, during, and after the use of the HRD. Pre-CPB ACT was 167 ± 89 secs (kaolin) and 99 ± 7 secs (celite), and APTT was 34 ± 5 secs. The HRD run time averaged 27.4 ± 1.5 mins targeted to remove 90{\%} total body heparin. Use of the HRD was not associated with any adverse hemodynamic reactions or increases in plasma free hemoglobin. The heparin concentration immediately following CPB was 4.65 ± 0.24 units/mL, with ACT >1000 secs and APTr >150 secs in all animals. During heparin removal, total body heparin content followed first-order exponential depletion kinetics. At the end of the HRD run, heparin concentration decreased to 0.51 ± 0.09 units/mL, with kaolin ACT returning to 177 ± 22 secs, celite ACT returning to 179 ± 17 secs, and APTT returning to 27 ± 3 secs (p > .05 vs. pre-CPB baseline for all variables). Conclusions: The HRD is capable of reversal of anticoagulation following CPB without significant blood cell damage or changes In hemodynamics. The HRD, therefore, can serve as an alternative to achieve heparin clearance in clinical situations where use of protamine may be contraindicated.",
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    T1 - Extracorporeal heparin adsorption following cardiopulmonary bypass with a heparin removal device - An alternative to protamine

    AU - Tao, Weike

    AU - Deyo, Donald J.

    AU - Brunston, Robert L.

    AU - Vertrees, Roger A.

    AU - Zwischenberger, Joseph B.

    PY - 1998

    Y1 - 1998

    N2 - Objectives: To evaluate the therapeutic efficacy and applicability of a heparin removal device (HRD) based on plasma separation and poly-L-lysine (PLL) affinity adsorption as an alternative to protamine in reversing systemic heparinization following cardiopulmonary bypass (CPB). Design: A prospective study. Setting: University research laboratory. Subjects: Adult female swine (n = 7). Interventions: Female Yorkshire swine (n = 7, 67.3 ± 3.5 [SEM] kg) were subjected to 60 mins of right atrium-to-aortic, hypothermlc (28°C) CPB. After weaning from CPB, the right atrium was recannulated with a two-stage, dual-lumen cannula which was connected to an HRD via extracorporeal circulation. Blood flow was drained at 1431.2 ± 25.4 mL/min from the inferior vena cava, through the plasma separation chamber of the HRD (where heparin was bound to PLL), and reinfused into the right atrium. The HRD run time was determined by a previously established mathematical model of first-order exponential depletion. Measurements and Main Results: Heart rate, mean arterial pressure, pulmonary arterial pressure, central venous pressure, kaolin and celite activated clotting time (ACT), activated partial thromboplastin time (APTT), heparin concentration, and plasma free hemoglobin were obtained before, during, and after the use of the HRD. Pre-CPB ACT was 167 ± 89 secs (kaolin) and 99 ± 7 secs (celite), and APTT was 34 ± 5 secs. The HRD run time averaged 27.4 ± 1.5 mins targeted to remove 90% total body heparin. Use of the HRD was not associated with any adverse hemodynamic reactions or increases in plasma free hemoglobin. The heparin concentration immediately following CPB was 4.65 ± 0.24 units/mL, with ACT >1000 secs and APTr >150 secs in all animals. During heparin removal, total body heparin content followed first-order exponential depletion kinetics. At the end of the HRD run, heparin concentration decreased to 0.51 ± 0.09 units/mL, with kaolin ACT returning to 177 ± 22 secs, celite ACT returning to 179 ± 17 secs, and APTT returning to 27 ± 3 secs (p > .05 vs. pre-CPB baseline for all variables). Conclusions: The HRD is capable of reversal of anticoagulation following CPB without significant blood cell damage or changes In hemodynamics. The HRD, therefore, can serve as an alternative to achieve heparin clearance in clinical situations where use of protamine may be contraindicated.

    AB - Objectives: To evaluate the therapeutic efficacy and applicability of a heparin removal device (HRD) based on plasma separation and poly-L-lysine (PLL) affinity adsorption as an alternative to protamine in reversing systemic heparinization following cardiopulmonary bypass (CPB). Design: A prospective study. Setting: University research laboratory. Subjects: Adult female swine (n = 7). Interventions: Female Yorkshire swine (n = 7, 67.3 ± 3.5 [SEM] kg) were subjected to 60 mins of right atrium-to-aortic, hypothermlc (28°C) CPB. After weaning from CPB, the right atrium was recannulated with a two-stage, dual-lumen cannula which was connected to an HRD via extracorporeal circulation. Blood flow was drained at 1431.2 ± 25.4 mL/min from the inferior vena cava, through the plasma separation chamber of the HRD (where heparin was bound to PLL), and reinfused into the right atrium. The HRD run time was determined by a previously established mathematical model of first-order exponential depletion. Measurements and Main Results: Heart rate, mean arterial pressure, pulmonary arterial pressure, central venous pressure, kaolin and celite activated clotting time (ACT), activated partial thromboplastin time (APTT), heparin concentration, and plasma free hemoglobin were obtained before, during, and after the use of the HRD. Pre-CPB ACT was 167 ± 89 secs (kaolin) and 99 ± 7 secs (celite), and APTT was 34 ± 5 secs. The HRD run time averaged 27.4 ± 1.5 mins targeted to remove 90% total body heparin. Use of the HRD was not associated with any adverse hemodynamic reactions or increases in plasma free hemoglobin. The heparin concentration immediately following CPB was 4.65 ± 0.24 units/mL, with ACT >1000 secs and APTr >150 secs in all animals. During heparin removal, total body heparin content followed first-order exponential depletion kinetics. At the end of the HRD run, heparin concentration decreased to 0.51 ± 0.09 units/mL, with kaolin ACT returning to 177 ± 22 secs, celite ACT returning to 179 ± 17 secs, and APTT returning to 27 ± 3 secs (p > .05 vs. pre-CPB baseline for all variables). Conclusions: The HRD is capable of reversal of anticoagulation following CPB without significant blood cell damage or changes In hemodynamics. The HRD, therefore, can serve as an alternative to achieve heparin clearance in clinical situations where use of protamine may be contraindicated.

    KW - Cardiopulmonary bypass

    KW - Extracorporeal circulation

    KW - Heparin

    KW - Poly-L- lysine

    KW - Protamine

    KW - Swine

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