scholarly journals A Cardiopulmonary Bypass Based Blood Management Strategy in Adult Cardiac Surgery

2017 ◽  
Vol 20 (5) ◽  
pp. 195 ◽  
Author(s):  
Ali Baran Budak ◽  
Kevin McCusker ◽  
Serdar Gunaydin
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Transfusion ◽  
Artery Bypass ◽  
Postoperative Hemorrhage ◽  
Control Group ◽  
Transfusion Rate ◽  
Blood Conservation ◽  
Transfusion Guidelines ◽  
Adult Cardiac Surgery

Background: Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open-heart surgical procedures. Efforts should be made to decrease or completely avoid transfusions to avoid these negative reactions.Methods: Our coronary artery bypass grafting database was reviewed retrospectively and a total of 243 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) were studied in a 12-month period (January-December 2016) after the implementation of the new program, and compared with 275 patients of the previous 12-month period.All the staff involved in the care of the patients were educated about the risks and benefits of blood transfusions and the new transfusion guidelines in a 45-min training. We revised our guidelines for transfusions based on the STS. A transfusion log was created. Reduction in IV fluid volume was targeted. CPB circuitry was redesigned to achieve significantly less prime volume. Results: The proportion of patients transfused with red blood cells was 56% (n =154) in the control group and reduced by 26.8% in the study group (29.2%; 71 patients; P < .01). Blood transfusion rate (1.7 ± 1/3.05 ± 1 units), postoperative hemorrhage (545 ± 50/ 775 ± 55 mL), respiratory support duration (12.4 ± 7/16.8 ± 8 h) and ICU stay (2.2±1.1/ 3.5±1.2 days) were significantly better in the blood conservation group.  Conclusion: These findings, in addition to risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in adult cardiac operations. 

The scope of the problem

Perfusion ◽  
1993 ◽  
Vol 8 (1_suppl) ◽  
pp. 1-5 ◽  
Author(s):  
Kenneth M Taylor
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Surgical Technique ◽  
Blood Transfusion ◽  
Cell Activation ◽  
Blood Product ◽  
Aminocaproic Acid ◽  
Blood Product Transfusion ◽  
Blood Conservation ◽  
Pharmacological Agents

Despite refinements in cardiac surgical technique, disorders of haemostasis remain a significant problem, reflecting the effects of cardiopulmonary bypass on blood cell activation and coagulation. Increased understanding of the dangers of blood and blood product transfusion have shifted the goals from blood replacement to blood conservation in cardiac surgery. Two approaches to blood conservation are used: autotransfusion and administration of pharmacological agents. These approaches may be complementary, but the latter approach- preventing or at least modifying the haemostatic disorder- may be preferable. This paper reviews some of the pharmacological agents that have been used in an attempt to conserve blood, including e-aminocaproic acid, desmopressin, prostacyclin, tranexamic acid, dipyridamole, and aprotinin. None of these agents has been able to eliminate the need for blood transfusion in all patients; aprotinin has been successful, however, in eliminating the need for transfusion in some patients and dramatically reducing the need in others.

Absence of Beneficial Effect of Acute Normovolemic Hemodilution Combined with Aprotinin on Allogeneic Blood Transfusion Requirements in Cardiac Surgery

2002 ◽  
Vol 96 (2) ◽  
pp. 276-282 ◽  
Author(s):  
Laurent Höhn ◽  
Alexandre Schweizer ◽  
Marc Licker ◽  
Denis R. Morel
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Blood Transfusion ◽  
Allogeneic Blood ◽  
Surgical Patients ◽  
Control Group ◽  
Acute Normovolemic Hemodilution ◽  
Normovolemic Hemodilution ◽  
Normal Cardiac Function

Background The efficacy of acute normovolemic hemodilution (ANH) in decreasing allogeneic blood requirements remains controversial during cardiac surgery. Methods In a prospective, randomized study, 80 adult cardiac surgical patients with normal cardiac function and no high risk of ischemic complications were subjected either to ANH, from a mean hematocrit of 43% to 28%, or to a control group. Aprotinin and intraoperative blood cell salvage were used in both groups. Blood (autologous or allogeneic) was transfused when the hematocrit was less than 17% during cardiopulmonary bypass, less than 25% after cardiopulmonary bypass, or whenever clinically indicated. Results The amount of whole blood collected during ANH ranged from 10 to 40% of the patients' estimated blood volume. Intraoperative and postoperative blood losses were not different between control and ANH patients (total blood loss, control: 1,411 +/- 570 ml, n = 41; ANH: 1,326 +/- 509 ml, n = 36). Allogeneic blood was given in 29% of control patients (median, 2; range, 1-3 units of packed erythrocytes) and in 33% of ANH patients (median, 2; range, 1-5 units of packed erythrocytes; P = 0.219). Preoperative and postoperative platelet count, prothrombin time, and partial thromboplastin time were similar between groups. Perioperative morbidity and mortality were not different in both groups, and similar hematocrit values were observed at hospital discharge (33.7 +/- 3.9% in the control group and 32.6 +/- 3.7% in the ANH group; nonsignificant) Conclusions Hemodilution is not an effective means to lower the risk of allogeneic blood transfusion in elective cardiac surgical patients with normal cardiac function and in the absence of high risk for coronary ischemia, provided standard intraoperative cell saving and high-dose aprotinin are used.

scholarly journals MODIFIED ULTRAFILTRATION IN ADULT CARDIAC SURGERY IS IT REALLY BENEFICIAL?

2007 ◽  
Vol 14 (04) ◽  
pp. 653-658
Author(s):  
SAFDAR ABBAS ◽  
M. SHAHAB NAQVI ◽  
Muhammad BAKHSH ◽  
Nouman Saddique
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Transfusion ◽  
Clinical Assessment ◽  
Postoperative Bleeding ◽  
Inotropic Support ◽  
Excess Water ◽  
Group I ◽  
Transfusion Requirements ◽  
Adult Cardiac Surgery

Background: Cardiopulmonary bypass initiates systemic inflammatoryresponse syndrome (SIRS) causing deleterious effects on various body systems with increased morbidity. Modifiedultrafiltration (MUF) is a technique that removes excess water and inflammatory mediators from the circulation in thepost-bypass period resulting in reduced bleeding, less blood transfusion requirements and overall reduced morbidity.Materials and Methods: 96 patients were randomly selected and divided into two groups. In Group I called MUF group(n=50), modified ultrafiltration was carried out for 15 min in the post bypass period. Group II called NON-MUFgroup(n=46), MUF was not carried out. Clinical assessment was based on ASA class. Mean cardiopulmonary bypass andaortic cross clamp times were 95.42 &56.94 min and 77.98 & 43.64 min in the MUF & NON-MUF groups respectively.Variables were expressed as mean and percentage. In the MUF group , there was increase in Hb by more than 2g/dlin 32 patients (64%) whereas in the NON-MUF group, this increase was only in 12 patients (20%). Mean postoperativechest drainage was far less (422 ml) in MUF group as compared to NON-MUF group (842.50 ml).Transfusion(449.12ml Vs 996.58 ml) and postoperative ventilatory requirements(40% Vs 47.8%) were also less in MUF group thanNON-MUF group. Inotropic support was nearly comparable in both the groups but overall morbidity (Low cardiac outputstate, sepsis, reopening) was less in the MUF group (18%) as compared to NON-MUF group (30%). Mean ICU staywas also less in MUF group (mean 51.52 hrs) than in NON-MUF group (mean 55.43 hrs). One patient in each groupdied. Conclusion: Modified Ultrafiltration is associated with improved hemoglobin, less postoperative bleeding,reopening and transfusion requirements with overall reduced morbidity and ICU stay. However, the need for inotropeswere not significantly different in the two groups.

scholarly journals Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts

2013 ◽  
Vol 95 (3) ◽  
pp. 207-210 ◽  
Author(s):  
C Kearsey ◽  
J Thekkudan ◽  
S Robbins ◽  
A Ng ◽  
S Lakshmanan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Bypass Grafts ◽  
The Mean

Introduction Currently, around 35–80% of patients undergoing cardiac surgery in the UK receive a blood transfusion. Retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit has been suggested as a possible strategy to reduce blood transfusion during cardiac surgery. Methods Data from 101 consecutive patients undergoing isolated coronary artery bypass grafts (where RAP was used) were collected prospectively and compared with 92 historic patients prior to RAP use in our centre. Results Baseline characteristics (ie age, preoperative haemoglobin [Hb] etc) were not significantly different between the RAP and non-RAP groups. The mean pump priming volume of 1,013ml in the RAP group was significantly lower (p<0.001) than that of 2,450ml in the non-RAP group. The mean Hb level at initiation of bypass of 9.1g/dl in patients having RAP was significantly higher (p<0.001) than that of 7.7g/dl in those who did not have RAP. There was no significant difference between the RAP and non-RAP groups in transfusion of red cells, platelets and fresh frozen plasma, 30-day mortality, re-exploration rate and predischarge Hb level. The median durations of cardiac intensive care unit stay and in-hospital stay of 1 day (interquartile range [IQR]: 1–2 days) and 5 days (IQR: 4–6 days) in the RAP group were significantly shorter than those of the non-RAP group (2 days [IQR: 1–3 days] and 6 days [IQR: 5–9 days]). Conclusions In the population group studied, RAP did not influence blood transfusion rates but was associated with a reduction in duration of hospital stay.

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

scholarly journals Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thiago Augusto Azevedo Maranhão Cardoso ◽  
Gudrun Kunst ◽  
Caetano Nigro Neto ◽  
José de Ribamar Costa Júnior ◽  
Carlos Gustavo Santos Silva ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Volatile Anesthetic ◽  
Serum Levels ◽  
Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery

2014 ◽  
Vol 34 (5) ◽  
pp. 53-60 ◽  
Author(s):  
Menglin Tang ◽  
Mei Feng ◽  
Lijun Chen ◽  
Jinmei Zhang ◽  
Peng Ji ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Bloodstream Infections ◽  
Control Group ◽  
Microbiological Analysis ◽  
Blood Conservation ◽  
Blood Samples ◽  
Potential Sources ◽  
Catheter System ◽  
Group 3 ◽  
Interventional Group

Background Arterial catheters are potential sources of nosocomial infection. Objective To investigate use of a closed blood conservation device in preventing catheter-related bloodstream infections in children after cardiac surgery. Methods Children with an indwelling arterial catheter after cardiac surgery were randomly assigned to 2 groups: a control group with a conventional 3-way stopcock in the catheter system and an interventional group with the conservation device in the catheter system. Catheter tips, catheter intraluminal fluid, and blood samples obtained from the catheter and peripherally were cultured for microbiological analysis. RESULTS Intraluminal fluid contamination was significantly lower (P = .03) in the interventional group (3 of 147 catheters) than in the control group (10 of 137 catheters). The 2 groups did not differ significantly in the rate of tip colonization (9 of 147 vs 12 of 137; P = .40) or in the number of catheter-related bloodstream infections (0 of 147 vs 2 of 137; P = .21). Conclusion Use of a closed blood conservation device could decrease the incidence of catheter-related contamination of intraluminal fluid.

Sign in / Sign up

Export Citation Format

Share Document