CARDIOVASCULAR
ENGINEERING
Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
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CARDIOVASCULAR
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Volume 2, 1997, No 1 |
Abstract:
An activation of the inflammatory system similar to that seen
during SIRS and septic shock is precipitated during
cardiopulmonary bypass. There is a complex interaction between
the endothelium, platelets and leucocytes and activation is
mediated through numerous biochemically active compounds. The
risk of an inflammatory response can be reduced by the use
pharmacological agents; or by affecting the impact of the
leucocytes themselves. Leucocyte depletion by filtration is a
simple, and potentially a very effective method of achieving a
suppression of the inflammatory response, and is an attractive
option as this requires no drug administration. Leucocyte
depletion has generated very favourable results, both from animal
work and research on cardiopulmonary transplant patients, such as
prolonged organ preservation and better organ function. For
patients receiving leucocyte depleted blood reperfusate it has
been shown that heart ultrastructure is better maintained and
biologically active agents are attenuated. In vivo results of
arterial line leucocyte depletion using filtration show a
decrease in patient ventilator time, and cost effectiveness due
to a reduced length of hospital stay. Further means of improving
this promising technology are already in sight. Increased
capabilities for systemic leucocyte removal should allow for more
extensive attenuation of the inflammatory response. Additionally,
attempts to target the timing of leucocyte depletion could mimic
the phases of leucocyte activation. The goal is to achieve
greater pulmonary and other organ protection allowing for
improved patient care, and reduced patient morbidity and
mortality.
Keywords:
ischaemia, reperfusion injury, leucocyte depletion, SIRS, septic
shock, cardiopulmonary bypass
Address for Correspondence:
Reference:
(CVE. 1997; 2 (1): 34-54)
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