Effect of Retrograde Autologous Blood Priming of Cardiopulmonary Bypass on Hemodynamic Parameters and Pulmonary Mechanics in Pediatric Cardiac Surgery: A Randomized Clinical Study

Singab, Hamdy; Gamal, Mohamed; Refaey, Reda; Altaher, Waleed A. M.

doi:10.1053/j.semtcvs.2020.09.006

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Retrograde autologous priming (RAP) has an important role in preservation of blood as well as improvement in hemodynamics and pulmonary mechanics in pediatric cardiac surgery. [28][29][30][31] It is a maneuver performed before initiation of CPB to replace a crystalloid primed circuit partially or completely with patients' own blood using arterial and/or venous cannulas. I usually perform RAP in children weighing >10 kg with low risk of hemodynamic instability.…”

Section: Operative Stagementioning

confidence: 99%

A Surgeon's Perspective on Blood Conservation Practice in Pediatric Cardiac Surgery

Karimi

2022

World J Pediatr Congenit Heart Surg

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Blood conservation practice in pediatric cardiac surgery has not been consistently adopted as quality improvement in many centers despite known risks associated with allogeneic blood products, shortage of donors, and costs. There are many blood conservation strategies available which collectively minimize exposure to allogeneic transfusion by maximizing the use of autologous red cells. These strategies are safe, reproducible, and have been implemented in clinical practice collectively with great efficacy for all patient ages and complexity levels. Institutional commitment to a set guideline will improve their blood conservation practice and quality outcome. The purpose of this article is to provide early career and practicing congenital cardiac surgeons with practical information concerning blood conservation strategies which can be considered for implementation in any pediatric cardiac surgery program, and which may be of particular value in resource-limited programs.

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Section: Operative Stagementioning

confidence: 99%

A Surgeon's Perspective on Blood Conservation Practice in Pediatric Cardiac Surgery

Karimi

2022

World J Pediatr Congenit Heart Surg

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Commentary: Less Bloody and Bloodless Cases

Desai

Yerebakan

2021

Seminars in Thoracic and Cardiovascular Surgery

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A novel approach to retrograde autologous priming for infant, pediatric and adult populations undergoing congenital heart surgery

Deptula,

Olshove,

Oldeen

et al. 2024

Perfusion

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Introduction Retrograde Autologous Priming (RAP) of cardiopulmonary bypass (CPB) circuits is an effective way to reduce prime volume, commonly through the transfer of prime into separate reservoirs or circuit manipulation. We describe a simple and safe technique for RAP without the need for any circuit modifications or manipulations. Methods For this technique, a separate roller pump for ultrafiltration (UF) is used. After adequate heparinization and arterial cannulation, the UF pump is initiated slowly, removing prime through the effluent of the UF, replacing with the patient’s blood from the aortic cannula. Once the arterial line and UF circuit are autologous primed, the arterial head displaces reservoir crystalloid toward the UF circuit at a flow rate equal to the UF pump, displacing the crystalloid prime with blood from the UF circuit, autologous priming the boot and oxygenator with blood, crystalloid again being removed by the effluent. After venous cannulation, the venous line prime is replaced with autologous blood, the crystalloid removed by the effluent of the UF circuit via the arterial head. During RAP, if the patient becomes hypovolemic, either autologous volume is transfused back to the patient, or CPB is initiated, without the need for circuitry modifications. Results The patient population in this sample consisted of 63 patients ranging between 6.1 kg and 115.6 kg. The smaller the patient, the less blood volume available for RAP and therefore the less prime volume able to be removed. Overall percent removal increases as our patients size increases compared to total circuit volume. Conclusion This RAP technique is a safe and effective way to achieve a standardized asanguinous prime for many regardless of patient or circuit size in the absence of contraindications such as low starting hematocrit, emergency surgery or physiologic instability. Most importantly, this potentially reduces the amount of hemodilution patients see from CPB initiation and therefore the lowest nadir hematocrit and consequently the amount of required homologous blood products needed during surgery.

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Effect of Retrograde Autologous Blood Priming of Cardiopulmonary Bypass on Hemodynamic Parameters and Pulmonary Mechanics in Pediatric Cardiac Surgery: A Randomized Clinical Study

Cited by 3 publications

References 34 publications

A Surgeon's Perspective on Blood Conservation Practice in Pediatric Cardiac Surgery

A Surgeon's Perspective on Blood Conservation Practice in Pediatric Cardiac Surgery

Commentary: Less Bloody and Bloodless Cases

A novel approach to retrograde autologous priming for infant, pediatric and adult populations undergoing congenital heart surgery

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