"Stolen" blood flow: effect of an open arterial filter purge line in a simulated neonatal CPB model.

The purpose of this study was to evaluate the effect of different flow rates and pressures on the degree of shunting of blood flow by the arterial filter purge line in a simulated neonatal cardiopulmonary bypass circuit. The circuit was primed with heparinized bovine blood (hematocrit 24%) and postfilter pressure was varied from 60-180 mm Hg (20 mm Hg increments) using a Hoffman clamp. Trials were conducted at flow rates ranging from 200-600 ml/min (100 ml/min increments). During trials conducted at a postfilter pressure of 60 mm Hg, 42.6% of blood flow was shunted through the purge line at a flow rate of 200 ml/min, whereas only 12.8% of flow was diverted at a flow rate 600 ml/min. During trials conducted at a postfilter pressure of 180 mm Hg, 82.8% of blood flow at 200 ml/min and 25.9% of blood flow at 600 ml/min was diverted through the open arterial purge line. The results of this study confirm that a significant amount of flow is diverted away from the patient when the arterial purge line is open. Shunting of blood flow through the arterial purge line could result in less effective tissue perfusion, particularly at low flow rates and high postfilter pressures. To minimize hypoperfusion injury, a flow probe (distal to the arterial filter) may be used to monitor real-time arterial flow in the setting of an open arterial filter purge line.