FILTERS USED IN CARDIOPULMONARY BYPASS EMBOLISM DEFINITION: obstruction of an artery, by a clot of blood or an air bubble. This emboli is categorized to Biological emboli Foreign emboli Gaseous emboli There are current technologies to decrease this embolic event delivered to patient Membrane oxygenators FILTER Blood surface coating Bubble traps Emboli detection system Blood Filters Depth filters Consist of packed fibers of Dacron wool or polyurethane foam . No defined pore size These filters have large wetted surface areas to filter the blood by absorption , they are effective in trapping gross bubbles. Screen filters composed of a woven mesh of polyester fibers defined pore sizes From 20 -40 μm (all of the arterial line filters used are the screen type)

1. FILTERS USED IN
CARDIOPULMONARY
BYPASS
GLORY MINI MOL. A

2. EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air
bubble.
• This emboli is categorized to
oBiological emboli
oForeign emboli
oGaseous emboli

3. BIOLOGICAL EMBOLI FOREIGN EMBOLI GASEOUS EMBOLI
BLOOD
• CLOTS
• FAT
• BONE FRAGMENTS
• FIBRIN
• FOAM
• TINY TUBING FRAGMENTS DUE TO
SPALLINATION OF ROLLER
• THREADS
• CANULATION SITE
• OPEN ATRIUM OR VENTRICLE
MICRO MACRO
EMBOLI EMBOLI
< 40 MICRON >40 MICRON

4. Non gaseous micro emboli reported
during cardiopulmonary bypass
• Microthrombi(fibrin)
• Platelet aggregates
• Neutrophil aggregates
• Red cell aggregates
• Denatured protein
• Fat or lipids
• Cold-reacting antibodies
• Bone fragments
• Muscle fragments
• Calcium particles
• Cotton fibers
• Plastic particles
• Filter materials
• Tubing materials
• Metal
• Talc
• Thread
• Bone wax
• Microfibrillar collagen
• Silicon antifoam

5. There are current technologies to decrease this embolic event delivered to
patient
• Membrane oxygenators
•FILTER
• Blood surface coating
• Bubble traps
• Emboli detection system

6. FILTERS USED IN CARDIOPULMONARY BYPASS

7. Blood Filters
Depth filters
• Consist of packed fibers of Dacron wool or
polyurethane foam .
• No defined pore size
• These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
• composed of a woven
mesh of polyester fibers
• defined pore sizes
• From 20 -40 μm
• all of the arterial line filters used are the
screen type

8. FILTER TYPE FILTER FUNCTION PORE SIZE FIGURE
ARTERIAL LINE FILTER
Used to remove micro emboli
including gas emboli, fat
emboli and cellular debris.
20 - 40 microns
Pre-CPB filters
Used during the priming to
remove particulate
contamination from circuit
primer (Bacterial ,
microbial ,and endotoxin)
0.2 μm.
(μm = micrometer = 1 (1/1000
millimeter
Gas line filters
Used to remove particulate
and microbial
contamination from gas lines
0.02 μm

9. Leukocyte
depletion filters
Reduces the levels of
leukocytes from the arterial
line or cardioplegia system .
>40μm
Cardioplegic
Solution Filters
By filtration of crystalloid
solution
0.2-5 μm.
Blood
Transfusion
filters
used for
more effective elimination of
harmful blood
components, micro-
aggregates, and non-blood
component particulate matter
SCREEN FILTER OR DEPTH
FILTER OR COMBINATION OF
BOTH
10-40 μm
Cell sever
(Cell salvage)
Used to remove debris such as
foreign matter, fibrin,
and cell clumps from salvaged
blood .
20- 40μm.

10. ARTERIAL FILTER
• Important component that limits the sources of embolic load to the
patient through the perfusion circuit.
• Arterial line filters are screen type composed of a woven mesh

11. HEMOCONCENTRATOR OR ULTRAFILTER
• consist of hollow fiber semipermeable microporous membrane that
allows the passage of water and electrolytes from the blood back to
the circuit and waste to filtrate bag.
• Pore size: 180-200 μm in diameter and pores of 5-10 nm.

12. CYTOSORB
• CytoSorb cartridge consists of a highly porous high-tech polymer
• The tiny beads can bind to a wide range of inflammatory mediators
such as cytokines, chemokines, and anaphylline toxins by virtue of
their structure, provided there is a corresponding gradient between
whole blood and polymer.

14. WHEN TO USE
SEPSIS:
• hyperinflammation
Onset of shock within the last 24 hrs
Signs of capillary leak – e.g. positive fluid balance
• Development of at least one more organ dysfunction
Kidney, lung, liver, coagulation, neurologic impairment
• Systemic markers of infection
PCT > 3 ng/l in case of bacterial or fungal sepsis
High IL-6 levels (e.g. >500 pg/ml)

15. INTRAOPERATIVE USE
At the start of CPB in case of one or more of
the following risk factors:
Age > 75 yrs
Preoperative activation of the immune
system
• Endocarditis
• Cardiac failure with inotropic therapy
• Preoperative leukocytosis (> 12,000/μl)
• Organ dysfunctions, e.g. kidney or liver
Long CPB duration expected (>120 min)
High risk for postoperative need for ECMO
Procedures with higher risk for complications
and/or SIRS
• Combination procedures (valve repair/-
replacement, CABG)
• Redo procedures
• Aortic surgery with hypothermic circulatory
arrest
• LVAD implant
Anytime during CPB Patients with low
primary risk but unexpected course
• Unexpected, significant prolongation of
anticipated CPB time
• Intraoperative development of a severe SIRS
• Intraoperative complications with expected
development of severe SIRS

16. POSTOPERATIVE USE
Immediately upon arrival in ICU
• Postoperative continuation of
intraoperative CytoSorb treatment
• Manifest severe SIRS upon arrival
Postoperative (0-48h) development of SIRS
with or without proof of infection
• Patient cannot be stabilized clinically with
standard medical treatment
• Impaired hemodynamics (shock)
 Onset of shock (Norepinephrine >
0,3μg/kg/min or rapidly increasing)
Signs of capillary leak – e.g. positive fluid
balance
Onset of at least one more organ
dysfunction
• Mechanical ventilation
• Acute kidney failure with need for
RRT
Systemic markers of infection
• PCT > 3ng/l in case of bacterial or
fungal sepsis –
• High IL-6 levels (e.g. > 500 pg/ml)