A multicenter investigation into the occurrence of high-pressure excursions

Abstract

The occurrence of sudden increases in premembrane pressures and membrane pressure differentials has drawn considerable attention and debate in the perfusion community. Several terms have been applied to this phenomenon, but the term that best describes this event is "high-pressure excursion" (HPE). The exact causes of HPE are still uncertain, but nonetheless widely speculated. However, their increased appearance seems to be very closely related to the removal/absence of human serum albumin from priming solutions. To investigate the reasons why HPE occur in some cardiopulmonary bypass cases, we present our findings in a multicenter, retrospective analysis of 2696 cardiopulmonary bypass cases. Of the 31 cases of HPE that were documented from the analysis, 60 preoperative and perioperative variables were gathered from the participating tertiary care centers. Our findings indicate that these pressure excursions had an occurrence of 1.14% in the three centers involved with this analysis. The largest occurrence of HPE tended to be in male (87.1%) coronary artery disease patients (96.8%) during the presence of the IV anesthetic Diprivan (74.2%). In conclusions, HPE are not perfusate related because it occurred in the presence of three perfusate combinations. They also do not seem to be oxygenator related or exclusive to hypothermic temperatures or heat exchangers.