Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery

Golab, Hanna D.; Takkenberg, Johanna J.M.; Gerner-Weelink, Gerri L. van; Wijers, Marianne J; Scohy, Thierry V.; Jong, Peter L. de; Bogers, Ad J.J.C.

doi:10.1510/icvts.2006.141226

Cited by 25 publications

(13 citation statements)

References 15 publications

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“…Thus, there have been reports about reducing the priming volume in congenital cardiac surgery. Several of these reports focused on priming without transfusion or even congenital cardiac surgery without transfusion . However, in most cases, the sample size was insufficient, or the lowest hematocrit level was not presented .…”

Section: Discussionmentioning

confidence: 99%

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

et al. 2013

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Reducing the cardiopulmonary bypass (CPB) priming volume in congenital cardiac surgery is important because it is associated with fewer transfusions. This retrospective study was designed to compare safety and transfusion volumes between the mini-volume priming (MP) and conventional priming (CP) methods. Between 2007 and 2012, congenital heart surgery using CPB was performed on 480 infants (≤5 kg): the MP method was used in 331 infants (MP group, 69.0%), and the CP method was used in 149 infants (CP group, 31.0%). In the MP group, narrow-caliber (3/16″) tubing was used, and the pump heads were vertically aligned to shorten the tubing lengths. The smallest possible oxygenators and hemofilters were used, and vacuum drainage was applied. Ultrafiltration was vigorously applied during CPB to avoid excessive hemodilution. The mean age and body weight of the patients were 48 ± 41 (0-306) days and 3.8 ± 0.8 (1.3-5.0) kg, respectively. The total priming and transfusion volumes during CPB were lower in the MP group than in the CP group (141 ± 24 mL vs. 292 ± 50 mL, P< 0.001, and 82 ± 40 mL vs. 162 ± 82 mL, P < 0.001, respectively). In the MP group, the smallest priming volume was 110 mL. However, there was no significant difference in the lowest hematocrit level during CPB between the two groups (22 ± 3% vs. 22 ± 3%, P = 0.724). The incidence of postoperative neurological complications was not significantly different between the MP and CP groups (1.8% vs. 2.7%, P = 0.509). After adjustment for the Risk Adjustment for Congenital Heart Surgery category, body surface area, and age, MP was not an independent risk factor of postoperative neurological complications or early mortality (P = 0.213 and P = 0.467, respectively). The MP method reduced the priming volume to approximately 140 mL without increasing the risk of morbidity or mortality in infants ≤5 kg. The total transfusion volume during CPB was reduced by 50% without compromising hematocrit levels. We recommend the use of mini-volume priming, which is a safe and effective method for reducing transfusion volumes.

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Section: Discussionmentioning

confidence: 99%

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

et al. 2013

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“…The prime was always completed with an amount of HA determined by the group assignment, 0.5 g kg À1 BW mannitol, 4.2 IU heparin ml À1 priming volume and 2-5 ml NaHCO 3 8.4%. All patients received standard general anesthesia as previously reported [10]. Activated clotting time was monitored during the bypass and preserved above 480 s. Nonpulsatile CPB, with mild hypothermia of 28-32 8C, was performed with blood flow rates between 1.8 and 3.2 l min À1 m À2 to maintain venous oxygen saturation above 70% and mean arterial pressure between 40 and 60 mmHg.…”

Section: Cpb Anesthesia and Anticoagulationmentioning

confidence: 99%

Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study

Golab

Scohy

Jong

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The COP regulatory strategy for neonatal and infant CPB, based upon the 5% concentration of albumin in the priming and a COP target of 18 mmHg during bypass, better preserves the plasma albumin concentration within the physiological range and stabilizes the colloid pressure than the standard strategy (0.5 gkg(-1) albumin in the priming and bypass COP target at 15 mmHg). Nevertheless, only the lower postoperative plasma lactate concentration and the shorter duration of mechanical ventilation in the high COP group indicated the potential clinical benefit of this new strategy.

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“…Details of the CPB technique and postoperative transfusion criteria were described previously. 4 The total amount of the priming volume and the RBC used in the prime and during CPB were compared between the groups. Hematocrit (Hct), platelet count and fibrinogen concentration were measured one day before the operation, after the induction of anesthesia and during CPB at 5 min on bypass and at the end.…”

Section: Methodsmentioning

confidence: 99%

Small, smaller, smallest. Steps towards bloodless neonatal and infant cardiopulmonary bypass

Golab

Bogers

2009

Perfusion

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In open heart surgery in neonates and small children, the cardiopulmonary bypass circuit surface and the priming volume are relatively large in relation to patient size and blood volume. Therefore, the use of allogeneic blood is inevitable to maintain the optimal hematocrit level during bypass. To avoid the deleterious effects of blood transfusion, as well as to reduce the contact surface of blood with artificial materials, we stepwise reduced the bypass circuit size. Use of the commercially available minimized elements and an adjusted set-up of the system allowed us to reduce usage of allogeneic blood in the prime and during the bypass. However, other supplemental measures are needed to obtain asanguineous cardiopulmonary bypass for neonatal and infant patients.

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Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery

Cited by 25 publications

References 15 publications

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study

Small, smaller, smallest. Steps towards bloodless neonatal and infant cardiopulmonary bypass

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