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Luckraz H, Giri R, Wrigley B, Nagarajan K, Senanayake E, Sharman E, Beare L, Nevill A. Balanced forced-diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes. J Card Surg 2021; 36:4125-4131. [PMID: 34414606 PMCID: PMC9292049 DOI: 10.1111/jocs.15925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/18/2021] [Indexed: 12/19/2022]
Abstract
Objectives Forced‐diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced‐diuresis with the RenalGuard® system (RG) during CPB. Methods Patients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e‐GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group). Results The use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post‐op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar. Conclusions Balanced forced‐diuresis with the RG reduced AKI rates after on‐pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.
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Affiliation(s)
- Heyman Luckraz
- Department of Cardiothoracic Surgery, Consultant Cardiothoracic Surgeon, American Hospital, Dubai, UAE
| | - Ramesh Giri
- Department of Cardiothoracic Anaesthesiology, Consultant Cardiothoracic Anaesthesiologist, Heart & Lung Centre, Wolverhampton, UK
| | - Benjamin Wrigley
- Department of Cardiology, Consultant Interventional Cardiologist, Heart & Lung Centre, Wolverhampton, UK
| | - Kumaresan Nagarajan
- Department of Cardiothoracic Surgery, Heart & Lung Centre, Wolverhampton, UK
| | - Eshan Senanayake
- Department of Cardiothoracic Surgery, Heart & Lung Centre, Wolverhampton, UK
| | - Emma Sharman
- Research Nurse, Research & Development Department, Heart & Lung Centre, Wolverhampton, UK
| | - Lawrence Beare
- Department of Cardiothoracic Surgery, Chief Clinical Perfusionist, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Alan Nevill
- Department of Statistics, Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Walsall, UK
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2
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Gupta S, McEwen C, Basha A, Panchal P, Eqbal A, Wu N, Belley-Cote EP, Whitlock R. Retrograde autologous priming in cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 60:1245-1256. [PMID: 34417595 DOI: 10.1093/ejcts/ezab334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/01/2021] [Accepted: 06/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Guidelines recommend retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit. However, the efficacy and safety of RAP is not well-established. We performed a systematic review and meta-analysis to determine the effects of RAP on transfusion requirements, morbidity and mortality. METHODS We searched Cochrane Central Register of Controlled Trials, Medline, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature and Embase for randomized controlled trials (RCTs) and observational studies comparing RAP to no-RAP. We performed title and abstract review, full-text screening, data extraction and risk of bias assessment independently and in duplicate. We pooled data using a random effects model. RESULTS Twelve RCTs (n = 1206) and 17 observational studies (n = 3565) were included. Fewer patients required blood transfusions with RAP [RCTs; risk ratio 0.58 [95% confidence interval (CI): 0.51, 0.65], P < 0.001, and observational studies; risk ratio 0.65 [95% CI: 0.53, 0.80], P < 0.001]. The number of units transfused per patient was also lower among patients who underwent RAP (RCTs; mean difference -0.38 unit [95% CI: -0.72, -0.04], P = 0.03, and observational studies; mean difference -1.03 unit [95% CI: -1.76, -0.29], P < 0.006). CONCLUSIONS This meta-analysis supports the use of RAP as a blood conservation strategy since its use during cardiopulmonary bypass appears to reduce transfusion requirements.
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Affiliation(s)
- Saurabh Gupta
- Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Charlotte McEwen
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ameen Basha
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Puru Panchal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Adam Eqbal
- Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Wu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Cote
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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Hensley NB, Gyi R, Zorrilla-Vaca A, Choi CW, Lawton JS, Brown CH, Frank SM, Grant MC, Cho BC. Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis. Anesth Analg 2021; 132:100-107. [PMID: 32947294 DOI: 10.1213/ane.0000000000005151] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients. METHODS This study involved a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of RAP in cardiac surgery involving CPB. The primary outcome was intraoperative allogeneic red cell transfusion. Secondary outcomes included whole hospital allogeneic transfusions and adverse events such as acute kidney injury (AKI) and stroke. RESULTS A total of 11 RCTs (n = 1337 patients) were included, comparing RAP patients (n = 674) to control (n = 663). In addition, 10 observational studies (n = 2327) were included, comparing RAP patients (n = 1257) to control (n = 1070). Overall, RAP was associated with a significantly reduced incidence of intraoperative red cell transfusion (n = 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI], 0.22-0.55, P < .001) compared to controls. This effect was seen among RCTs (n = 10 studies; OR = 0.19; 95% CI, 0.08-0.45, P < .001) and observational studies (n = 8 studies; OR = 0.66; 95% CI, 0.50-0.87, P = .004) in isolation. RAP was also associated with a significantly reduced incidence of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI, 0.19-0.41, P < .001). Among the studies that reported AKI and stroke outcomes, there was no statistically significant increased odds of AKI or stroke in either RAP or control patients. CONCLUSIONS Based on the pooled results of the available literature, RAP is associated with a significant reduction in intraoperative and whole hospital allogeneic red cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical patients and thus, lessen transfusions. Additional high-quality prospective studies are necessary to determine the ideal priming volume necessary to confer the greatest benefit without incurring organ injury.
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Affiliation(s)
- Nadia B Hensley
- From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Richard Gyi
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | | | - Chun W Choi
- Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer S Lawton
- Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles H Brown
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Steve M Frank
- From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael C Grant
- From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brian C Cho
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
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Singab H, Gamal MA, Refaey R, Al-Taher W. Effect of Retrograde Autologous Blood Priming of Cardiopulmonary Bypass on Hemodynamic Parameters and Pulmonary Mechanics in Pediatric Cardiac Surgery: A Randomized Clinical Study. Semin Thorac Cardiovasc Surg 2020; 33:505-512. [PMID: 32977015 DOI: 10.1053/j.semtcvs.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022]
Abstract
The present study aimed to assess the impact of retrograde autologous priming (RAP) on hemodynamics and pulmonary mechanics in children subjected to cardiothoracic surgery. This prospective randomized study analyzed the clinical records of 124 children with risk adjustment in congenital heart surgery-1 left to right lesions subjected to cardiac surgery. They comprised 64 patients in RAP group and 60 patients in the conventional priming group. The preoperative, intraoperative and postoperative data of the studied patients were reported. The outcome measures included hematocrit (Hct) value, blood gases, lung mechanics parameters, transfusion needs, ICU stay, postoperative complications and mortality. Preoperatively, there were no significant differences between the studied groups regarding the demographic data, underlying lesions, laboratory data, blood gases and pulmonary mechanics parameters. Intraoperatively, RAP group patients had significantly lower amount of blood loss, less frequent need to packed red blood cells (RBC)s transfusion and better Hct values when compared with the control group. Postoperatively, RAP group patients had significantly higher Hct% at ICU arrival, significantly better pulmonary mechanics parameters and significantly shorter duration on mechanical ventilation. RAP in children older than 12 months subjected to cardiac surgery for risk adjustment in congenital heart surgery-1 left to right lesions is associated with less transfusion needs and better pulmonary mechanics.
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Affiliation(s)
- Hamdy Singab
- Cardiothoracic Surgery Department, Ain Shams University Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt.
| | - Mohamed A Gamal
- Cardiothoracic Surgery Department, Ain Shams University Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Reda Refaey
- Cardiothoracic Surgery Department, Ain Shams University Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Waleed Al-Taher
- Anesthesia and Intensive Care Department, Ain Shams University Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
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5
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Vranken NP, Babar ZU, Montoya JA, Weerwind PW. Retrograde autologous priming to reduce allogeneic blood transfusion requirements: a systematic review. Perfusion 2020; 35:574-586. [PMID: 32009539 PMCID: PMC7536507 DOI: 10.1177/0267659119895474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Efforts have been made to minimize transfusion of packed red blood cells in
patients undergoing cardiac surgery with cardiopulmonary bypass. One method
concerns retrograde autologous priming. Although the technique has been used
for decades, results remain contradictory in terms of transfusion
requirements. Objective: This systematic literature review aimed to summarize the evidence for the
efficacy of retrograde autologous priming in terms of decreasing
perioperative packed red blood cell requirements in adults. Methods: Two researchers independently searched PubMed for articles published in the
past 10 years. The modified Cochrane collaboration Risk of Bias Tool and the
Research Triangle Institute Item Bank were used to assess bias. Results: Eight studies were included, of which two randomized and six observational
studies. Five studies, including one randomized study, report a significant
decrease in packed red blood cell use in the retrograde autologous priming
group compared to no retrograde autologous priming used. All studies are
flawed by at least a high risk bias of bias score on one item of the bias
assessment. Conclusion: Although most studies reported significantly fewer packed red blood cell
transfusions in the retrograde autologous priming group, it is important to
note that relatively few articles are available which are flawed by several
types of bias. Prospective, randomized multi-center trials are warranted to
conclude decisively on the benefits of retrograde autologous priming.
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Affiliation(s)
- Nousjka Pa Vranken
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Zaheer Ud Babar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jesse A Montoya
- Perfusion Sciences Program, Department of Pharmacology, The University of Arizona, Tucson, AZ, USA
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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The Effect of Standardizing Autologous Prime Techniques in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 51:227-237. [PMID: 31915406 DOI: 10.1182/ject-1900016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 11/27/2019] [Indexed: 11/20/2022]
Abstract
Autologous priming (AP) of the extracorporeal circuit has been used as a technique to reduce iatrogenic anemia in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to review the results of standardizing AP techniques to reduce variation among clinicians and its effect on clinical outcomes. Standardized goal-directed protocols for AP were established by the cardiac team and applied to all adult cardiac surgical patients where CPB was used. Following Institutional Review Board approval, data were analyzed for two sequential groups of patients: Non-standardized AP (NST-AP) and standardized AP (ST-AP). Exclusion criteria included pre-CPB hemodynamic instability and preoperative hematocrit (Hct) values less than 30%. The primary end point was the transfusion of red blood cells (RBCs), whereas secondary end points included Hct change and other perioperative allogeneic blood product transfusions. Data are presented as mean and SD. Of the 192 patients evaluated, 82 were in the NST-AP group and 110 in the ST-AP group. There were no preoperative demographic differences across groups. Total AP volume was lower in the NST-AP group than in the ST-AP patients (486.8 ± 259.6 mL vs. 1,048.2 ± 218.7 mL, p < .001). Whereas pre-CPB Hct values were identical between the groups, the first on-CPB (25.7% ± 4.5% vs. 27.9% ± 4.2%, p < .001), high CPB (27.7% ± 3.5% vs. 29.1% ± 3.6%, p < .008), and first postoperative (32.5% ± 4.0% vs. 34.3% ± 3.9%, p < .003) were all significantly higher in ST-AP patients. Perioperative transfusion rate was higher in NST-AP patients (63.6%) vs. ST-AP (44.6%), p < .01. There was no difference in intraoperative RBC transfusion, but postoperatively, more patients in the NST-AP group received RBCs than those in the ST-AP group (51.2% vs. 28.2%, p < .01). The application of an ST-AP protocol was effective in reducing hemodilution, which was associated within higher Hcts and lower postoperative transfusion rates.
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7
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Rafiee M, Toutounchi MZ, Yazdani R, Mohammadi N. Effect of Retrograde Autologous Priming on Clinical Outcome of Cardiopulmonary Bypassing on Patients Undergoing Coronary Artery bypass Grafting. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2019. [DOI: 10.29252/ijcp-26691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Saito C, Kamei T, Kubota S, Yoshida K, Hibiya M, Hashimoto S. Association of Primary Hemodilution and Retrograde Autologous Priming with Transfusion in Cardiac Surgery: Analysis of the Perfusion Case Database of the Japanese Society of Extra-Corporeal Technology in Medicine. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2018; 50:231-236. [PMID: 30581230 PMCID: PMC6296452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
It is important to avoid unnecessary blood cell transfusion. However, the associations of hemodilution and retrograde autologous priming with red blood cell transfusion during and after cardiopulmonary bypass (CPB) in cardiac surgery in Japan are currently unclear. We analyzed these associations using data for 3,090 adults from the Perfusion Case Database of the Japanese Society of Extra-Corporeal Technology in Medicine. Percent hemodilution was calculated by total priming volume and weight. Logistic regression models were used to adjust for covariates including type of surgery, gender, age, hemoglobin concentration before CPB, CPB time, urine volume during CPB, and institution. The percentages of red blood cell transfusions during CPB for patients with <15, 15 to <20, 20 to <25, 25 to <30, and ≥30% hemodilution were 43.0, 51.5, 68.9, 77.3, and 87.7%, respectively. This increase in line with increasing dilution was significant after adjusting for covariates. The percentage of red blood cell transfusion after CPB also increased slightly between 39.0 and 49.4% with percent hemodilution, but the trend after adjusting for covariates was not significant. Use of retrograde autologous priming was significantly associated with blood cell transfusion during CPB after adjusting for covariates, but was not significantly related to blood cell transfusion after CPB. These results suggest that optimizing the percent hemodilution and use of retrograde autologous priming might reduce the use of red blood cell transfusion during CPB in clinical practice in Japan.
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Affiliation(s)
- Chihiro Saito
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tetsuya Kamei
- Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan
| | - Shoji Kubota
- Asahikawa City Hospital, Department of Clinical Engineering, Asahikawa, Hokkaido, Japan; and
| | - Kiyoshi Yoshida
- Osaka University Graduate School of Medicine, Department of Advance Clinical Engineering, Suita, Osaka, Japan
| | - Makoto Hibiya
- Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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9
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Blessing JM, Riley JB. Lean Flow: Optimizing Cardiopulmonary Bypass Equipment and Flow for Obese Patients-A Technique Article. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2017; 49:30-35. [PMID: 28298663 PMCID: PMC5347216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
The goal of this chart review was to investigate the use of down-sized cardiopulmonary bypass (CPB) circuits for obese patients. The effects of transitioning from larger to smaller oxygenators, reservoirs, and arteriovenous tubing loops were evaluated through a retrospective review of 2,816 adult non-congenital procedure perfusion records. This technique report and case series is a continuation of our original prescriptive CPB circuit quality improvement project. An algorithm was derived to adjust body surface area (BSA) to lower body mass index (BMI) to provide down-sized extracorporeal circuit components capable of meeting the metabolic needs of the patient. As a result of using smaller circuits, decreased priming volumes led to significantly increased hemoglobin (HB) nadirs (p < .05) leading to significant decreases in homologous donor blood product exposures (p < .05). Patients with large BSAs were supported safely with smaller circuits by using lean body mass (LBM)-adjusted BSA and target blood flow algorithm. Based on this case series, large BMI patients may be safely supported with smaller circuits selected based on BSAs adjusted more toward LBM. Use of smaller circuits in high BMI patients led to higher HB nadirs and less donor blood components during the surgical procedure. Renal function and hospital stay were not affected by this approach.
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10
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Cheng M, Li JQ, Wu TC, Tian WC. Short-Term Effects and Safety Analysis of Retrograde Autologous Blood Priming for Cardiopulmonary Bypass in Patients with Cardiac Valve Replacement Surgery. Cell Biochem Biophys 2016; 73:441-446. [PMID: 27352335 DOI: 10.1007/s12013-015-0661-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This randomized, double-blind study evaluated the short-term effects and safety of perioperative retrograde autologous priming (RAP) for cardiopulmonary bypass (CPB) in patients with cardiac replacement surgery to determine if this approach is a better substitute for crystal liquids priming in patients with valvular heart disease. We observed that RAP significantly decreased the actual priming volume, preserved the hematocrit and hemoglobin level during CPB to a certain degree, and decreased lactate accumulation in CPB period. Moreover, RAP lowered the volume of transfusion and dosage blood products. Thus, our results showed that RAP approach effectively improved tissue perfusion and lowered intraoperative Lac levels, by reducing the hemodilution, which safely and reliably improve the microcirculation perfusion.
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Affiliation(s)
- Ming Cheng
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China.
| | - Jun-Quan Li
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China.
| | - Tian-Chi Wu
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Wei-Chen Tian
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China
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11
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Fu GW, Nie YF, Jiao ZY, Zhao WZ. Clinical applications of retrograde autologous priming in cardiopulmonary bypass in pediatric cardiac surgery. ACTA ACUST UNITED AC 2016; 49:e5138. [PMID: 27119427 PMCID: PMC4849968 DOI: 10.1590/1414-431x20165138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/03/2016] [Indexed: 11/21/2022]
Abstract
Retrograde autologous priming (RAP) has been routinely applied in cardiac pediatric
cardiopulmonary bypass (CPB). However, this technique is performed in pediatric
patients weighing more than 20 kg, and research about its application in pediatric
patients weighing less than 20 kg is still scarce. This study explored the clinical
application of RAP in CPB in pediatric patients undergoing cardiac surgery. Sixty
pediatric patients scheduled for cardiac surgery were randomly divided into control
and experimental groups. The experimental group was treated with CPB using RAP, while
the control group was treated with conventional CPB (priming with suspended red blood
cells, plasma and albumin). The hematocrit (Hct) and lactate (Lac) levels at
different perioperative time-points, mechanical ventilation time, hospitalization
duration, and intraoperative and postoperative blood usage were recorded. Results showed that Hct levels at 15 min after CPB
beginning (T2) and at CPB end (T3), and number of intraoperative blood transfusions
were significantly lower in the experimental group (P<0.05). There were no
significant differences in CPB time, aortic blocking time, T2-Lac value or T3-Lac
between the two groups (P>0.05). Postoperatively, there were no significant
differences in Hct (2 h after surgery), mechanical ventilation time, intensive care
unit time, or postoperative blood transfusion between two groups (P>0.05). RAP can
effectively reduce the hemodilution when using less or not using any banked blood,
while meeting the intraoperative perfusion conditions, and decreasing the
perioperative blood transfusion volume in pediatric patients.
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Affiliation(s)
- G W Fu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y F Nie
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Z Y Jiao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - W Z Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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