Re: How to perform a haemodialysis using the arterial and venous lines of an extracorporeal life support.

摘要

I read with interest the article by El-Essawi and co-workers [1] on the comparison between a minimized perfusion circuit (MPC) versus conventional cardiopulmonary bypass (CCPB). There is little doubt that novel strategies aiming to reduce the systemic inflammatory response (SIR) induced by CPB should be sought. Whether MPC is such a strategy remains a point of controversy, and while the article presented by El-Essawi and co-workers seems encouraging, a comparison between their groups is difficult. It has been established that field-aspirated blood may increase the incidence of the thrombotic, bleeding and inflammatory complications of CPB [2]. I believe that the discrepancy in the use of a cell-saver device between the groups of patients challenges the robustness of the presented data and their interpretation, as the amplitude of the observed SIR may differ independently of the perfusion strategy used. The fact that a cell-saver device was used in only two patients in the CCPB group, while over 30% of patients in the MPC group had their field-aspirated blood washed, centrifuged and re-transfused may have contributed to the benefits observed in the MPC group. Nevertheless, the authors should be congratulated on their excellent results, and the clear demonstration of the safety and efficacy of their MPC setup.