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Platelet Function During Cardiopulmonary Bypass Using Multiple Electrode Aggregometry: Comparison of Centrifugal and Roller Pumps
Author(s) -
Kehara Hiromu,
Takano Tamaki,
Ohashi Noburo,
Terasaki Takamitsu,
Amano Jun
Publication year - 2014
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12299
Subject(s) - cardiopulmonary bypass , protamine , chemistry , platelet , anesthesia , heparin , fibrinogen , activated clotting time , medicine , biochemistry
Blood trauma may be lower with centrifugal pumps ( CP s) than with roller pumps ( RP s) during cardiopulmonary bypass ( CPB ), because, unlike RP s, CP s do not compress the tubing, and shear stress is considered lower in CP s than in RP s. However, relative platelet function remains unclear. Using multiple electrode aggregometry ( MEA ), we compared platelet function with CP and RP . Ten swine underwent CPB for 3 h, with five weaned off using CP and five using RP . Platelet function was measured using MEA , as were hemoglobin concentration and platelet count, before sternotomy, after heparin infusion, 30 min and 3 h after starting CPB , after protamine infusion, and 60 min after stopping CPB . Platelet activation was initiated with adenosine diphosphate ( ADP ), arachidonic acid ( AA ), and thrombin receptor‐activating protein 6 ( TRAP ). Fibrinogen, platelet factor 4 ( PF 4), and β‐thromboglobin (β‐ TG ) concentrations were measured before sternotomy and 60 min after stopping CPB . In the CP group and using ADP , aggregation was significantly reduced 30 min ( P = 0.019) and 3 h ( P = 0.027) after starting CPB , recovering to baseline 60 min after CPB was stopped. In the RP group, aggregation was significantly decreased 30 min ( P = 0.007) and 3 h ( P = 0.003) after starting CPB and after protamine administration ( P = 0.028). With AA , aggregation significantly decreased 30 min after starting CPB in both the CP ( P = 0.012) and RP ( P = 0.016) groups, slightly increasing 3 h after starting CPB and after protamine infusion, and recovering to baseline 60 min after CPB cessation. With TRAP , aggregation in the CP and RP groups decreased 30 min after starting the pump, although changes were not significant; aggregation gradually recovered after 3 h and returned to baseline 60 min after the pumps were stopped. There were no significant differences at all sampling points of MEA . In both groups, fibrinogen, PF 4, and β‐ TG concentrations were similar 60 min after pump cessation and before sternotomy. Platelet function, evaluated with MEA , was lowest 30 min after CPB was started but did not decrease over time in either group. As assessed by MEA , platelet function using CP and RP did not differ significantly. Platelet dysfunction was caused mainly by initial contact with foreign materials and may not be dependent on type of pump.