A Comparative Study of Cardiopulmonary Bypass with Nonblood and Blood Prime

Verska, Joseph J.; Ludington, Louis G.; Brewer, Lyman A.

doi:10.1016/s0003-4975(10)65720-7

Cited by 37 publications

(7 citation statements)

References 14 publications

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“…The post-operative thromboplastin time was more prolonged in haemodilution and re-exploration groups than in controls, whilst the highest thrombocyte counts were encountered in haemodiluted patients. These findings are analogous to those of Verska et al [20] and also agree with the studies of Lilleaasen [11]. De Leva!…”

Section: Controlsupporting

confidence: 93%

“…i.e. acute normovolaemic haemodilution im mediately before operation and hypothermic cardiopulmonary bypass with non-haemic 1 This study has been supported in part by grants from the Turku University Foundation and the Medi cal Research Council of the Academy of Finland. priming, has gained increasing acceptance in open-heart surgery, even in coronary artery bypass grafting [4,[19][20][21], As to the advan tages of the method, extreme haemodilution has been reported to reduce the need of donor blood and to decrease the risks of transfusion reactions and scrum hepatitis. In addition, return of the fresh autologous blood at the end of the operation provides platelets and other clotting factors as well as helps to main tain optimal oxygen transport characteristics in the blood.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Extreme Haemodilution on the Immediate Post-Operative Course of Coronary Artery Bypass Patients

Niinikoski¹,

Laato²,

Laaksonen³

et al. 1983

Eur Surg Res

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The immediate post-operative course was investigated in 70 patients who had undergone coronary artery bypass grafting under normovolaemic moderate and subsequent extreme haemodilution, and in 70 control patients who underwent a similar operation with a haemic prime in the heart-lung machine. Altogether 8 patients (5.7%), 4 from the haemodilution group and 4 from the controls required re-exploration for excessive post-operative bleeding and were examined as their own group. There were no marked differences in bleeding through chest tubes or in blood haemoglobin concentration between patients who had undergone intra-operative haemodilution and controls. Post-operatively both patient groups required approximately analogous amounts of infused blood, colloids and crystalloids. Central venous pressure was consistently lower in haemodiluted patients. Opening of peripheral circulation as indicated by a rise in skin temperature occurred significantly faster in haemodiluted patients than in controls. Before and after weaning from the respirator, arterial blood oxygen tension was slightly lower in patients who had undergone intra-operative haemodilution. Serum creatinine levels were lower and blood platelet counts significantly higher in haemodiluted patients than in controls. Rates of peri-operative myocardial infarctions showed no essential difference between the groups.

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Section: Controlsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Effects of Extreme Haemodilution on the Immediate Post-Operative Course of Coronary Artery Bypass Patients

Niinikoski¹,

Laato²,

Laaksonen³

et al. 1983

Eur Surg Res

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“…Hemodilution of varying degrees is cur rently employed during open-heart opera tions to combat the hypothermia-induced impairment of blood fluidity, to reduce the need of homologous blood transfusions, and to provide autologous blood with normal clotting properties after cardiopulmonary by pass [5,6,14,[17][18][19]. The effects of the resulting diminution in the blood-oxygen transporting capacity on the myocardial oxy gen supply/dcmand balance were, however, poorly studied in the clinical situation of an…”

mentioning

confidence: 99%

Myocardial Oxygen Balance during Hemodilution in Patients Undergoing Coronary Artery Bypass Grafting

Jalonen¹,

Meretoja²,

Laaksonen³

et al. 1984

Eur Surg Res

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The myocardial (arterial-coronary sinus) balance of oxygen and lactate was studied before a cardiopulmonary bypass and during the first 5 min of a normothermic bypass in two patient groups undergoing coronary revascularization for multiple coronary artery disease. The hemodilution (HD) group was hemodiluted before the bypass with dextran 70 (15 ml/kg; resulting mean hematocrit 32%) and further at the beginning of the bypass due to nonhemic priming of the oxygenator (mean hematocrit 15%). The control (C) group was not diluted before the bypass, and four units of red blood cells were included in the oxygenator priming (mean hematocrit 27% after the beginning of the bypass). The preoperative dilution produced a decline in the coronary sinus blood oxygen tension and oxygen saturation, but no change in the arterial-coronary sinus lactate balance. After the first 5 min of the bypass, the heart produced lactate in both the HD group and the C group, but the lactate production was more pronounced in the HD group. At the same time, the coronary sinus blood oxygen saturation was lower in the HD group than in the C group. Hypotension frequently accompanied the beginning of the bypass in both groups. It is concluded that the hemodilution to a hematocrit level of 32% in patients undergoing coronary revascularization for multiple stable coronary artery disease produces compensatory changes in myocardial oxygen extraction, but no changes of a generalized ischemia can be demonstrated. The hemodilution to a hematocrit level of 15 % produces myocardial ischemia in patients with a normothermic unloaded heart, adding to the effect of hypotension at the beginning of the bypass.

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“…It consisted of a mixture of Hartmann's solution, sodium bicarbonate, mannitol, and heparin in the quantities given in table 1. As a control (B) we used a mixture described in table 2. This contained the same amounts of sodium bicarbonate, heparin, and mannitol as fluid A, but instead of Hartmann's solution the same volume (2000 ml) of Plasmolyte 148 (Travenol) was used.…”

Section: Methodsmentioning

confidence: 99%

Chalk in the prime.

Yeo¹,

Doyle²,

Saynor³

et al. 1986

Thorax

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After observations of cloudiness in the perfusion circuit at open intracardiac operations, laboratory experiments showed a precipitate in a Hartmann's solution (compound sodium lactate solution, Ringer-lactate) and sodium bicarbonate based priming fluid used for cardiopulmonary bypass. The precipitate was found to consist of calcium carbonate crystals. The crystals were not dissolved by adding plasma proteins, nor were they sufficiently cleared from the extracorporeal circuit by a 40 gm filter in the arterial line. The crystals may embolise in microvascular beds and thus be a cause of postoperative morbidity. The practice of adding sodium bicarbonate to the pump prime may be unnecessary. In most open intracardiac surgery in adults a nonblood priming solution is used to fill the extracorporeal circuit before operation. The omission of homologous blood leads to improved tissue perfusion' and improved haemostasis2 3 and has simplified the logistics of open heart surgery. In 1982 72% of cardiopulmonary bypass operations in the United States were performed with physiological saline solution as a priming fluid and in 18% of these sodium bicarbonate was used as an additive.4 Only a few centres in the United Kingdom have used a prime containing sodium bicarbonate.We wish to report an adverse chemical reaction, which occurs in a prime containing Hartmann's solution (compound sodium lactate solution, Ringerlactate) and sodium bicarbonate and which may have important physiological consequences. From 1979 until December 1984 we used a prime based on Hartmann's solution (the composition of which is given in table 1). When we recently changed to a completely clear tubing (Portex) for use with the extracorporeal circuit, we noticed cloudiness in the priming fluid.From the ion content of the constituents of the prime it seemed possible that the cloudiness was due to the formation of calcium carbonate crystals, the calcium being provided by the Hartmann's solution and the carbonate component by sodium bicarbonate. The aim of this study was to identify the cause and chemical and physical characteristics of the cloudiness in the priming fluid. MethodsThe priming fluid (A) prepared in the laboratory was the same as the one used clinically. It consisted of a mixture of Hartmann's solution, sodium bicarbonate, mannitol, and heparin in the quantities given in table 1. As a control (B) we used a mixture described in table 2. This contained the same amounts of sodium bicarbonate, heparin, and mannitol as fluid A, but instead of Hartmann's solution the same volume (2000 ml) of Plasmolyte 148 (Travenol) was used. This has an ion content similar to that of Hartmann's solution, but does not contain calcium. All experiments were performed at room temperature (23°C) with 1/100 of the quantities of the fluids.Sediment for microscopic examination was obtained by allowing the prepared samples of prime to stand for 30 minutes. They were then centrifuged at 2500 rev/min for 10 minutes and the supernatant was aspirated until 0.5 ml of ...

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A Comparative Study of Cardiopulmonary Bypass with Nonblood and Blood Prime

Cited by 37 publications

References 14 publications

Effects of Extreme Haemodilution on the Immediate Post-Operative Course of Coronary Artery Bypass Patients

Effects of Extreme Haemodilution on the Immediate Post-Operative Course of Coronary Artery Bypass Patients

Myocardial Oxygen Balance during Hemodilution in Patients Undergoing Coronary Artery Bypass Grafting

Chalk in the prime.

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