Roller Versus Centrifugal Pumps – Perfusion

Roller Versus Centrifugal Pumps

John Ingram BS CCP

What is the Ideal/Optimal Pump What is the Ideal/Optimal Pump
Roller PumpsHow they WorkThe Proper Occlusion TechniquesAdvantages and Disadvantages Roller Pumps
How they Work How they Work
The Proper Occlusion Techniques The Proper Occlusion Techniques
Advantages and Disadvantages Advantages and Disadvantages
Centrifugal PumpsHow they WorkAdvantages and Disadvantages Centrifugal Pumps
How they Work How they Work
Advantages and Disadvantages Advantages and Disadvantages
Studies Studies

Optimal Blood Pump

Tayama et al. Suggested That the Ideal Blood Pump for ECC Must: Tayama et al. Suggested That the Ideal Blood Pump for ECC Must:
Have the Capacity to Deliver up to 7 l/min Against a Pressure of 500 mm Hg Have the Capacity to Deliver up to 7 l/min Against a Pressure of 500 mm Hg
Should not Damage the Cellular or Acellular Components of the Blood Should not Damage the Cellular or Acellular Components of the Blood
Should Have Smooth Surfaces Should Have Smooth Surfaces
Must be Free of Areas of Stasis or Turbulence Must be Free of Areas of Stasis or Turbulence
Should Have Accurate and Reproducible Flow Measurement Should Have Accurate and Reproducible Flow Measurement
Should Have a Back-up or Manual Mode of Operation in Case of Motor Failure Should Have a Back-up or Manual Mode of Operation in Case of Motor Failure

Roller Pumps – How They Work

The Propulsion of Blood Occurs by the Action of Two Rollers Sequentially Compressing a Segment of Tubing Causing the Forward Movement of Blood

Roller Pumps – Proper Occlusion

PRESSURE METHOD (can be done with sterile circuit primed) PRESSURE METHOD (can be done with sterile circuit primed)
Place Fluid Primed Tubing Inside Roller Head Place Fluid Primed Tubing Inside Roller Head
Must Have a Pressure Manometer Integrated into the Positive Flow Outflow Line Must Have a Pressure Manometer Integrated into the Positive Flow Outflow Line
Tighten Occlusion of the Pump until Fully Occluded Tighten Occlusion of the Pump until Fully Occluded
Clamp Outflow Line Immediately Beyond the Pressure Manometer Clamp Outflow Line Immediately Beyond the Pressure Manometer
Manually Rotate Pump Head until Manometer Reads 200 mmHg Manually Rotate Pump Head until Manometer Reads 200 mmHg
Slowly Back off the Occlusion until the Pressure Drops to 100 mmHg Over 1 Minute Slowly Back off the Occlusion until the Pressure Drops to 100 mmHg Over 1 Minute
Do the Same for the Other Roller on the Pump Do the Same for the Other Roller on the Pump

Roller Pumps – Proper Occlusion

WATER COLUMN METHOD (can not be done sterile) WATER COLUMN METHOD (can not be done sterile)
Place Tubing Inside Roller Head Place Tubing Inside Roller Head
Must Have a Bucket of Water with Inflow Outflow Lines under Water Must Have a Bucket of Water with Inflow Outflow Lines under Water
Circulate the Water to Prime the Lines Circulate the Water to Prime the Lines
Tighten Occlusion of the Pump unti Fully Occluded Tighten Occlusion of the Pump unti Fully Occluded
Hold Outflow Line Vertical with ends two Feet Above the Pump Head Hold Outflow Line Vertical with ends two Feet Above the Pump Head
Slowly Back off the Occlusion until the Fluid Level Drops 1 mm/min Slowly Back off the Occlusion until the Fluid Level Drops 1 mm/min
Do the Same for the Other Roller on the Pump Do the Same for the Other Roller on the Pump

Roller Pumps Advantages:

Less Expensive Less Expensive
Lower Prime Volume Lower Prime Volume
Easy to Prime Easy to Prime
Flow is not After Load Dependent * Flow is not After Load Dependent *
Reliable Constant Flow Rate Reliable Constant Flow Rate
Do Not Allow Retrograde Flow Do Not Allow Retrograde Flow

Roller Pumps Disadvantages:

Occlusive Occlusive
Are Not After Load Dependent Are Not After Load Dependent
Will Pump Against any Resistance and may Result in VesselDissection, Pump Tubing Disconnection or Rupture Will Pump Against any Resistance and may Result in Vessel

Dissection, Pump Tubing Disconnection or Rupture

Capable of Pumping Massive air Through the Outflow Line Capable of Pumping Massive air Through the Outflow Line

Preload Dependent

Highly Capable of Cavitation Highly Capable of Cavitation
As the Tubing Expands Behind the Roller, There is a Period of Negative Pressure As the Tubing Expands Behind the Roller, There is a Period of Negative Pressure
This Momentary Negative Pressure in theAbsence of Adequate Preload, May Induce The Cavitation Of Air Dissolved In The Solution This Momentary Negative Pressure in the Absence of Adequate Preload , May Induce The Cavitation Of Air Dissolved In The Solution

Hemolysis

The Magnitude of Hemolysis is Related to both the Time and Exposure of the Blood to Shear Forces Generated by the Pump The Magnitude of Hemolysis is Related to both the Time and Exposure of the Blood to Shear Forces Generated by the Pump
A Region of High Pressure and Shear Force is Created at the Leading Edge of the Roller Where the Tubing is Compressed A Region of High Pressure and Shear Force is Created at the Leading Edge of the Roller Where the Tubing is Compressed
Over Occlusion: Crushes the Cellular Components Causing Hemolysis Over Occlusion: Crushes the Cellular Components Causing Hemolysis
Under Occlusion: Causes Severe Forward and Backward Turbulence CausingShear Stress and Hemolysis Under Occlusion: Causes Severe Forward and Backward Turbulence Causing

Shear Stress and Hemolysis

Spallation

Particulate Emboli may be Generated by Micro Fragmentation (or Spallation) of the Inner Surface of the Tubing where the Roller Contacts the Tubing and where the Fold at the Edges of the Tubing Occurs Particulate Emboli may be Generated by Micro Fragmentation (or Spallation) of the Inner Surface of the Tubing where the Roller Contacts the Tubing and where the Fold at the Edges of the Tubing Occurs
Studies of Tubing wear over Time have shown that Polyvinylchloride Fragments Generated from Roller Pumps are Numerous, Frequently 20 mm in Diameter, and begin to Occur During the First Hour of use Studies of Tubing wear over Time have shown that Polyvinylchloride Fragments Generated from Roller Pumps are Numerous, Frequently 20 mm in Diameter, and begin to Occur During the First Hour of use

Centrifugal Pumps – How They Work

Are Nonocclusive Pumps that Function by Producing a Constrained Vortex Within a Polycarbonate Structure Are Nonocclusive Pumps that Function by Producing a Constrained Vortex Within a Polycarbonate Structure
The Inner Mechanism may Either be Cones or Impellers that Rotate at a High RPM The Inner Mechanism may Either be Cones or Impellers that Rotate at a High RPM
The High RPM Exerts an Outward Centrifugal Force on the Blood where the Outlet is Located, Where it Exits the Pump and Results in Forward Movement of Fluid The High RPM Exerts an Outward Centrifugal Force on the Blood where the Outlet is Located, Where it Exits the Pump and Results in Forward Movement of Fluid
Blood Flow Rate is Increased by Increasing the Revolutions per Minute Thereby Increasing the Centrifugal Force Exerted Blood Flow Rate is Increased by Increasing the Revolutions per Minute Thereby Increasing the Centrifugal Force Exerted
The Disposable Pump Head is Coupled to the Console Unit via Magnetic Motor Drive The Disposable Pump Head is Coupled to the Console Unit via Magnetic Motor Drive

Centrifugal Pumps Advantages

Non – Occlusive, will not Pump Against any Resistance Non – Occlusive, will not Pump Against any Resistance
Are After Load Dependent Are After Load Dependent
Less likely to Result in Vessel Dissection, Pump Tubing Disconnection or Rupture Less likely to Result in Vessel Dissection, Pump Tubing Disconnection or Rupture
Flow is Preload Dependent Flow is Preload Dependent
No Cavitation No Cavitation
Less Hemolysis Less Hemolysis
Will De-Prime when challenged with Gross Air Will De-Prime when challenged with Gross Air

Centrifugal Pumps Disadvantages

More Expensive More Expensive
Increased Prime Volume Increased Prime Volume
More Difficult to Prime More Difficult to Prime
Allow for Retrograde Flow Allow for Retrograde Flow
Less Likely to Result in Vessel Dissection, Tubing Rupture or Disconnection Less Likely to Result in Vessel Dissection, Tubing Rupture or Disconnection
Thrombus formation Low Anticoagulation / Long Pump Runs Thrombus formation Low Anticoagulation / Long Pump Runs
Heat Generation (Hemolysis, Clotting) Heat Generation (Hemolysis, Clotting)
Magnetic Decoupling Magnetic Decoupling

Research Studies:

A Number of Investigators have Performed in vitro Studies Comparing Centrifugal Pumps and Roller Pumps in Terms of Blood Handling During Short & Long- Term use

Tamari et al. Examined Hemolysis under Various Flow and Pressure Conditions in vitro using Porcine Blood and Concluded that the Hemolysis was Related to:

Duration of Blood Exposure to Shear Stress

The Pump Pressure of the Outflow

The Flow Rate of the Pump

Many Studies Reported Less Hemolysis with Centrifugal Pump When Tested in Vitro

Many Trials have been Conducted to Compare Centrifugal and Roller Pumps in Relation to Emboli Generation, Blood Trauma, and Clinical Outcomes

In a Randomized Trial by Wheeldon et al., Found Centrifugal Pump to Have

Significantly Less Micro-emboli Generation

Less Complement Activation

Better Preservation of Platelet Count was Observed in Patients with Centrifugal Pump

Many Trials have been Conducted to Compare Centrifugal and Roller Pumps in Relation to Emboli Generation, Blood Trauma, and Clinical Outcomes

In a Randomized Trial by Wheeldon et al., Found Centrifugal Pump to Have

Significantly Less Micro-emboli Generation

Less Complement Activation

Better Preservation of Platelet Count was Observed in Patients with Centrifugal Pump

Literature:

Bharat Datt, MSc, CCP, CPC, FPP; Moui B. Nguyen, CCP; Gary Plancher, CCP; Mark Ruzmetov, MD, PhD, SA-C; Michael O’Brien, PA-C; Alicia Kube, RN; Hamish M. Munro, MD, FRCA; Kamal K. Pourmoghadam, MD; William M. DeCampli, MD, PhD

The Impact of Roller Pump vs. Centrifugal Pump on Homologous Blood Transfusion in Pediatric Cardiac SurgeryJ Extra Corpor Technol. 2017;49:36–43 The Journal of ExtraCorporeal TechnologyThe Heart Center at Arnold Palmer Hospital for Children, Orlando, FloridaPresented at the 53rd AMSECT International Conference, Tampa, Florida, April 17 2015 and the Society for Advancement of Blood Management 2015 Annual Meeting240 Pediatric Patients140 Centrifugal Pump and 100 Roller PumpRoller Pump GroupDecreased Priming VolumeIncreased Hct Blood PrimesDecrease in Intra-Operative TransfusionsDecreased MortalityResearch Studies – Closing Comments

The Impact of Roller Pump vs. Centrifugal Pump on Homologous Blood Transfusion in Pediatric Cardiac Surgery

J Extra Corpor Technol. 2017;49:36–43 The Journal of ExtraCorporeal Technology

The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida

Presented at the 53rd AMSECT International Conference, Tampa, Florida, April 17 2015 and the Society for Advancement of Blood Management 2015 Annual Meeting

240 Pediatric Patients

140 Centrifugal Pump and 100 Roller Pump

Roller Pump Group

Decreased Priming Volume

Increased Hct Blood Primes

Decrease in Intra-Operative Transfusions

Decreased Mortality

Research Studies – Closing Comments

In researching the clinical benefits of one type of pump versus the other, in terms of hemolysis, inflammatory response (cytokines, complement, interleukins), fibrinolysis, platelet activation, etc., one is likely to discover many contradicting studies. There are likely as many studies claiming one type of pump over the other, in many short term and long term clinical aspects. For example there are studies demonstrating centrifugal pumps being more gentle (less hemolytic, etc.), however there are studies that conclude that even a poorly occlusive roller pump is less hemolytic than centrifugal pumps. There are many studies that have found no clinical difference in outcomes.

In the end, it remains the education of the perfusionist to research and conclude for one’s self which is best for their patients. However, there is one stand out characteristic that centrifugal pumps have above roller pumps, and that is in the area of Safety.

2 Comments

SARDJOEPERSAD AWINASHon May 7, 2021 at 2:26 pmPlease let me know through email for the Webinars.ReplySkrydalewicz Maciejon May 7, 2021 at 3:23 pmPlease visit from time to time our events calendar (you can add easily event to your phone calendar) your phone will remand you about upcoming webinars. 🙂Other way Please Subscribe our YouTube Channel – PerfWeb –https://www.youtube.com/c/TheNewOrleansConferenceThen click bell button, YouTube will let you know when we go live 🙂Other Option is, you can purchase our Critical Care / Perfusion Apphttps://perfusioneducation.com/perfusion-app/Each time you will use it – it will remand you about upcoming webinarsThank you for watch our Perfusion Education Webinars !!!Reply SARDJOEPERSAD AWINASH on May 7, 2021 at 2:26 pm

Please let me know through email for the Webinars.

Please let me know through email for the Webinars. Reply

Skrydalewicz Maciejon May 7, 2021 at 3:23 pmPlease visit from time to time our events calendar (you can add easily event to your phone calendar) your phone will remand you about upcoming webinars. 🙂Other way Please Subscribe our YouTube Channel – PerfWeb –https://www.youtube.com/c/TheNewOrleansConferenceThen click bell button, YouTube will let you know when we go live 🙂Other Option is, you can purchase our Critical Care / Perfusion Apphttps://perfusioneducation.com/perfusion-app/Each time you will use it – it will remand you about upcoming webinarsThank you for watch our Perfusion Education Webinars !!!Reply Skrydalewicz Maciej on May 7, 2021 at 3:23 pm

Please visit from time to time our events calendar (you can add easily event to your phone calendar) your phone will remand you about upcoming webinars. 🙂Other way Please Subscribe our YouTube Channel – PerfWeb –https://www.youtube.com/c/TheNewOrleansConferenceThen click bell button, YouTube will let you know when we go live 🙂Other Option is, you can purchase our Critical Care / Perfusion Apphttps://perfusioneducation.com/perfusion-app/Each time you will use it – it will remand you about upcoming webinarsThank you for watch our Perfusion Education Webinars !!!

Please visit from time to time our events calendar (you can add easily event to your phone calendar) your phone will remand you about upcoming webinars. 🙂

Other way Please Subscribe our YouTube Channel – PerfWeb – https://www.youtube.com/c/TheNewOrleansConference

Then click bell button, YouTube will let you know when we go live 🙂

Other Option is, you can purchase our Critical Care / Perfusion App https://perfusioneducation.com/perfusion-app/

Each time you will use it – it will remand you about upcoming webinars

Thank you for watch our Perfusion Education Webinars !!! Reply