A survey of priming solutions used for cardiopulmonary bypass

Abstract

We conducted a postal survey of all National Health Service centres where cardiac surgery is performed. We requested information about the priming solutions and additives used in the cardiopulmonary bypass circuit, and specifically asked whether changes were made in priming solutions for diabetic patients. Hartmann's solution was used by 63% of respondents, either alone or mixed with colloid. Heparin was added to the prime by 89% of respondents. Only two centres and one anaesthetist at a third centre altered the prime for diabetic patients.

The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction*

“…Mannitol, an osmotic diuretic, was the earliest pharmacological agent used for prophylaxis of ARF following cardiac surgery [6], but its usefulness has been debated ever since. Nearly 40% of cardiac units in the UK use mannitol as a component of the bypass pump prime [7]. Mannitol is freely filtered by the glomeruli, with a plasma half-life of 2.5 h [8], and <7% is reabsorbed [9], resulting in an increase in the osmotic pressure of the glomerular filtrate to produce a diuresis.…”

The effect of mannitol on renal function following cardio‐pulmonary bypass in patients with normal pre‐operative creatinine*

“…Mannitol was the earliest pharmacological prophylactic agent used to prevent ARF during cardiac surgery because it is an osmotic diuretic [8]. Mannitol is used in the pump prime in 37% of adult cardiac surgical units in the UK [9], but its use to preserve renal function in this setting remains controversial because the evidence of benefit is contradictory [8, 10–15]. This is due in part to the design of some previous studies, but also to the previous lack of sensitive tests for renal dysfunction [15].…”

Fluid and Electrolyte Therapy in Cardiac Surgery

“…Ancak, yine de birçok merkez priming solüsyonunda rutin olarak kolloid kullanmaya devam etmektedir. İngiltere'de sağlık bakanlığına bağlı 35 merkezde yapılan araştırmada, merkezlerin % 54'ünün yalnızca kristaloid priming solüsyonunu kullandığı, % 44'ünün ise kristaloid solüsyonuna sentetik kolloid ilave ettikleri tespit edilmiştir (42) . Albumin ile ilgili çalış-malarda, sonuç parametrelerinde anlamlı bir üstünlüğün gösterilememesi ve pahalı olması nedeni ile, başlangıç olüsyonuna konulmasının gerekmediği fikri genel kabul görmektedir.…”