Conventional haemofiltration during routine coronary bypass surgery

Abstract

The use of conventional ultrafiltration during cardiopulmonary bypass (CPB) has been well recognized as an efficient modality of therapy to reverse the effects of deliberate haemodilution. Routine use of the haemofilter was prospectively studied on 60 patients undergoing coronary artery bypass surgery. Group A consisted of 30 patients on whom the ultrafiltrator was used and compared to group B who did not receive the ultrafiltration technique. The COBE 1200 ultrafiltration device was used. The results of the study demonstrated that, in group A, the mean total amount of ultrafiltrate collected during bypass was 2510 +/- 804 ml per patient. The mean 24-h postoperative blood loss was 440 +/- 192 ml in group A and 451 +/- 136 ml in group B. The average bank blood transfused was 0.6 +/- 1.3 units per patient in group A and 0.75 +/- 1.5 units per patient in group B. Postoperative weight gain in group A averaged 3.5 +/- 3.45 lb per patient, compared to 4.8 +/- 3.7 lb per patient in group B. Postoperative length of stay averaged 6.4 +/- 1.5 days per patient in group A and 6.4 +/- 2.1 days per patient in group B. Overall patient charges averaged $33,706 +/- 8348 per patient in group A and $33,041 +/- 7674 per patient in group B. It was concluded that routine use of ultrafiltration during routine coronary artery bypass surgery with CPB offers no improvement in the quality of care nor does it decrease the patient's overall charges.

Impact of Ultrafiltration on Kidney Injury After Cardiac Surgery: The Michigan Experience

“…Few studies in cardiac surgery have focused, let alone reported, on the relationship between CUF and postoperative kidney injury [5,6]. Babka and colleagues [5] randomly assigned 60 patients undergoing CABG surgery to receive CUF.…”

“…Conversely, CUF may have an adverse consequence on kidney injury, mechanistically related to fluid shift imbalances and renal hypoperfusion. A few relatively small studies have explored the short-term risks associated with CUF, and have assessed kidney injury in a number of ways, including renal insufficiency, creatinine clearance (CrCl), and elevated postoperative creatinine [4][5][6][7]. Three of these studies were randomized trials [4][5][6]; two reported no significant difference associated with CUF in terms of renal insufficiency [4,5], whereas one reported a significantly lower adjusted 24-hour creatinine associated with CUF [6].…”

The impact of continuous haemofiltration with high-volume fluid exchange during cardiopulmonary bypass surgery on the recovery of patients with impaired renal function: a pilot randomised trial

“…This opinion is not supported by evidence from this study and other similar studies where the patterns of HCT were found to be similar. 61,62 Evidence from a recent meta-analysis also supports the idea that the need for blood transfusions is significantly reduced by ultrafiltration during cardiac surgery. 63 In addition, evidence from the latter study 62 also demonstrated that the platelet count after bypass was not significantly different from that in the non-haemofiltration group, an observation that is also in agreement with our findings.…”

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

“…Among these options, studies have shown that routine use of hemofiltration and/ or cell saver improves the quality of surgical care [4][5][6].…”