Document Type

Article

Publication Date

4-22-2025

Abstract

Background: High-pressure excursions (HPE) in oxygenators during cardiopulmonary bypass (CPB) are rare but clinically significant events that can lead to compromised perfusion and adverse patient outcomes. HPE occurs due to fibrin and platelet deposition within the oxygenator, leading to increased transmembrane pressure and potential obstruction of blood flow. Despite its clinical importance, HPE remains an underrecognized issue with limited standardized guidelines for detection, prevention, and management.

Methods: A comprehensive literature search was conducted across multiple databases and grey literature sources to identify studies reporting on HPE in CPB oxygenators. The selection process followed the PRISMA-ScR framework, with articles screened based on relevance to the research questions. Key findings were extracted, summarized, and classified according to study design and level of evidence.

Results: Twenty-two articles were initially identified, with six removed due to duplication. Following title and abstract screening, ten additional articles were excluded, leaving six articles for full-text review. No articles were removed at the full-text screening stage. The included studies highlighted key factors contributing to HPE, including oxygenator coating materials, priming solution composition, blood flow resistance, and patient-specific comorbidities. Heparin-coated and synthetic-coated oxygenators were associated with a lower incidence of HPE compared to uncoated oxygenators. Continuous monitoring of pre-membrane and post-membrane pressures was identified as an effective detection method, while the incorporation of albumin in priming solutions appeared as a potential preventive strategy. Management techniques such as adjusting blood flow, increasing FiO2, and warming the patient were also reported as effective interventions.

Conclusions: This scoping review provides a comprehensive synthesis of the current understanding of HPE in CPB oxygenators, emphasizing its clinical significance, detection, and management. While existing studies offer valuable insights, further research is needed to standardize definitions, establish preventive protocols, and optimize management strategies. Future prospective, multicenter studies are recommended to enhance the generalization of findings and improve patient outcomes in cardiac surgery.

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