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The effect of priming techniques of ultrafiltrators on blood rheology: an in vitro evaluation

Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, mkglogowski{at}home.com

Alfred H Stammers

Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska

Kevin S Niimi

Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska

Kimberly D Tremain

Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska

Michelle L Muhle

Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska

Cody C Trowbridge

Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska

The increased interest of using ultrafiltration during cardiopulmonary bypass (CPB) has mandated a re-evaluation of the hematological effects of this blood conservation process. ‘Rinse-free’ ultrafiltrators can be primed using either crystalloid or blood prior to use. It is unknown whether one priming technique results in superior results in ultrafiltration quality. An in vitro circuit was designed to evaluate the Sorin/COBE HC1400 (n=6), the Lifestream HC70 (n=6), and the Terumo/Sarns HC11 (n=6). All test conditions were conducted at a blood flow rate of 250 ml/min and a transmembrane pressure of 250 mmHg. Samples were drawn and analyzed at four distinct time points for hematocrit, total protein, plasma free hemoglobin, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor- (TNF). The HC11 had significantly greater percent increases in hematocrit under the blood priming protocol (29.2 ± 7.9) than either the HC1400 (11.0 ± 7.8, p<0.03) or the HC70 (11.9 ± 7.8, p<0.04). When crystalloid priming was compared to blood priming, the HC1400 and HC70 produced significant percent increases in hematocrit and total protein levels. The HC1400 devices produced significantly less plasma free hemoglobin when primed with crystalloid rather than blood (43.6 ± 38.3 vs 21.3 ± 5.6, p<0.01). There were no significant differences between devices or priming techniques for IL-6, IL-8 or TNF levels. In conclusion, the efficiency of the ultrafiltrators was elevated when primed with crystalloid before use. Cytokine levels were relatively unchanged with priming techniques, while plasma free hemoglobin levels were reduced with those devices previously primed with crystalloid.

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