Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Abstract

A b s t r a c tBackground: Commonly used cardiopulmonary bypass systems with cardiotomy reservoir, oxygenator, and roller pump require preoperative crystalloid filling. Radical reduction of the filling fluid volume and replacing it with the patient's own blood has a fundamental impact on the outcome. Aim:A comparison of cardiopulmonary bypass filled with the patient's blood, applied in Poland for the first time, and the classical system filled with crystalloids.Methods: Non-randomised trial in which patients undergoing coronary artery bypass grafting were divided into two groups: first operated on with use of cardiopulmonary bypass system with the patient's own blood priming, and a control group operated on with standard technique. Levels of haemoglobin (HGB), haematocrit (HCT), platelets, leukocytes, creatinine, protein, C-reactive protein, procalcitonin, volume of transfused blood products, postoperative drain output, time to extubation, and consumption of catecholamines were compared. Results:The results of a study comparing the classical system with the blood-filled system (n = 60) showed a significantly smaller decrease in HGB and HCT levels (p = 0.001), resulting in reduction of blood product transfusions by 75% (p = 0.03). The new type of extracorporeal circulation reduced the total postoperative drain output by approximately 28% (p = 0.003). The systemic inflammatory response syndrome (SIRS) was less pronounced and the tissue perfusion was better due to smaller degree of haemodilution leading to better organ and heart protection. The patients required shorter mechanical ventilation times in the perioperative period. Conclusions:The use of a new system of cardiopulmonary bypass filled with the patient's blood reduces the postoperative decrease in HGB and HCT, the amount of transfused blood products, and total postoperative drain output. It also shortens the time spent on mechanical ventilatory support.

Impact of Crystalloid or Albumin Priming of the Heart–Lung Machine on Inhospital Outcome after Coronary Artery Bypass Surgery

“…20,21 Crystalloid priming is deemed to favor postoperative SIRS. 16 Therefore, many authors The trend of epinephrine infusion shows a significantly higher dosage in patients subjected to the albumin groups after 48 hours. (D) The trend of norepinephrine therapy reveals a slightly higher dosage in the crystalloidtreated group after 48 hours (p > 0.05).…”

“…Substantial research has been conducted in recent years providing data on the advantages and safety of blood priming. 16,23 One of the major advantages of RAP is the reduced risk of allergic reactions and infectious disease transmission. 19 Most of the new minimal ECC systems are prefilled with less than half of the amount of normally used crystalloid; filling with blood leads to flushing back almost all crystalloid.…”

“…19 Most of the new minimal ECC systems are prefilled with less than half of the amount of normally used crystalloid; filling with blood leads to flushing back almost all crystalloid. 16 Therefore, RAP is also associated with a lesser degree of hemodilution and more stable hemoglobin. 24,25 Otherwise, at lower arterial blood pressures during CBP-related surgery, the reduction of plasma oncotic pressure using crystalloid priming is beneficial: the cited study showed that optimal oxygen exchange is achieved by the equilibration of plasma oncotic pressure and capillary hydrostatic pressure without altering the interstitial fluid volume.…”

“…14,15 On the one hand, SIRS has been associated with the use of crystalloid prefilling of the HLM, priming with the patient's own blood has become increasingly popular in recent years. 16 On the other hand, the so-called retrograde autologous blood priming (RAP) is not feasible in all patients, taking into account their advanced age and comorbidities such as CAD, aortic stenosis, peripheral and central arterial disease, and renal dysfunction, requiring stable tissue oxygenation and adequate blood pressure. These factors often forbid exsanguination of 1.5 to 2 L to prefill HLM tubing.…”

Hemoglobin Level Decrease after Open Heart Surgery in a Tertiary Hospital in Indonesia

“…6 Hemodilution will cause a decrease in hemoglobin (Hb) levels. 7 Besides hemodilution, hemolysis can also cause a decrease in hemoglobin levels. Hemolysis is the damage of the red blood cell membrane integrity, causing the hemoglobin released and its levels fall.…”