Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis

Sun, Peng; Ji, Bingyang; Sun, Yongkun; Zhu, Xian Lun; Liu, J; Long, Cun; Zhao, Zheng

doi:10.1177/0267659112474861

Cited by 54 publications

(33 citation statements)

References 26 publications

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“…This is of much importance in surgeries performed in Jehova's Witnesses [8]. Several studies have shown that any amount greater than 1 unit of PRBC transfused, regardless of the procedure performed, results in decreased life expectancy of the patient [9][10][11]. In contrast to our study, other publications compared standard CPB with the system in which low crystalloid filling was used, and the postoperative day 1 drain output was comparable in both groups [12].…”

Section: Discussioncontrasting

confidence: 54%

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

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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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.

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Section: Discussioncontrasting

confidence: 54%

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

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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“…Desmopressin enhances PLT function in patients with end‐stage renal failure and severe AS and was used for these indications in nine patients . Techniques such as cell salvage and use of RAP during CPB have also shown decreased allogeneic blood transfusion and are supported by the clinical guidelines for blood conservation . These techniques are employed in all cardiac blood conservation cases, if appropriate for the individual patient and hemodynamically tolerated.…”

Section: Discussionmentioning

confidence: 99%

Jehovah's Witnesses and cardiac surgery: a single institution's experience

et al. 2014

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Background Based on biblical doctrines, patients of the Jehovah's Witness faith refuse allogeneic blood transfusion. Cardiac surgery carries a high risk of blood transfusion, but has been performed in Jehovah's Witnesses for many years. The literature contains information on the outcomes of this cohort, but does not detail the perioperative care of these patients. This article describes a single institution's experience in perioperative care of Jehovah's Witnesses undergoing cardiac surgery. Study Design and Methods A chart review of adult Jehovah's Witness patients undergoing cardiac surgery at Duke University between January 2005 and June 2012 was completed. Institutional protocols regarding preoperative erythropoietin (EPO) therapy and intraoperative isovolemic hemodilution are detailed. Patient demographics and use of various blood conservation techniques are described. Hemoglobin (Hb) at various points throughout the perioperative management, hospital length of stay, and mortality are reviewed as indicators of outcome. Results Forty‐five Jehovah's Witness patients underwent cardiac surgery at Duke University Medical Center. Preoperative EPO increased the mean Hb by 1.2 g/dL before surgery. Intraoperative normovolemic hemodilution was used in 37 patients with intraoperative mean nadir Hb of 10.3 g/dL. Antifibrinolytics and desmopressin were commonly used as coagulation adjuncts. Mean cardiopulmonary bypass time was 137 minutes, with mean nadir temperature of 30.5°C. The mean length of hospital stay was 6.2 days, with mean intensive care unit stay of 1.7 days. This cohort had zero 90‐day mortality in the perioperative period. Conclusions This case series demonstrates that bloodless cardiac surgery can be performed in select patients refusing allogeneic blood transfusion.

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“…Analysis of our data showed a mean dilution gap of 2.77 g/dL for MCPB and of 4.47 g/dL for CCPB. Autologous priming may be used to avoid the drop in hemoglobin and has been shown to reduce transfusion requirements in meta-analysis data, but had no effect on outcome including ventilation and postoperative ICU stay (18). Hou et al confirmed these findings in a prospective randomized study in patients with a body surface of <1.5 m 2 .…”

Section: Discussionmentioning

confidence: 97%

Conventional or minimized cardiopulmonary bypass support during coronary artery bypass grafting? – An analysis by means of perfusion and body mass index

et al. 2018

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The use of minimized cardiopulmonary bypass support to reduce the side effects of extracorporeal circulation is still contradictorily discussed. This study compares perfusion operated by conventional (CCPB) and minimized (MCPB) cardiopulmonary bypass support during coronary artery bypass grafting (CABG). This study includes the data of 5164 patients treated at our department between 2004 and 2014. Tissue perfusion during cardiopulmonary bypass support and cardiac arrest was assessed by means of body mass index, hemodilution, blood pressure with corresponding pump flow and venous oxygen saturation, serum lactate, and serum pH. Hemodilution was more pronounced after CCPB: hemoglobin had dropped to 4.47 ± 0.142 g/dL after CCPB and to 2.77 ± 0.148 g/dL after MCPB (P = 0.0022). Despite the higher pump flow in conventional circuits (4.86–4.95 L/min vs. 4.1–4.18 L/min), mean blood pressure was higher during minimized bypass support (53 ± 10 vs. 56 ± 13 mm Hg [aortic clamping], 57 ± 9 vs. 61 ± 12 mm Hg [34°C], 55 ± 9 vs.59 ± 11 mm Hg [aortic clamp removal], P < 0.0001) at all time points. Venous oxygen saturation remained on comparable levels of >70% during both conventional and minimized cardiopulmonary bypass support. The increase in serum lactate was more pronounced after CCPB (8.98 ± 1.28 vs. 3.66 ± 1.25 mg/dL, P = 0.0079), corresponding to a decrease in serum pH to acidotic levels (7.33 ± 0.06 vs. 7.35 ± 0.06, P < 0.0001). These effects were evident in all BMI ranges. Minimized cardiopulmonary bypass support provides efficient perfusion in all BMI ranges and is thus equivalent to conventional circuits.

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Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis

Abstract: Compared to conventional priming, RAP could reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming. Further studies involving RAP are expected to investigate if this technique is beneficial to the patient.

Cited by 54 publications

References 26 publications

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

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

Jehovah's Witnesses and cardiac surgery: a single institution's experience

Conventional or minimized cardiopulmonary bypass support during coronary artery bypass grafting? – An analysis by means of perfusion and body mass index

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