Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial

Whitlock, Richard; Mathew, Joseph; Eikelboom, John W.; Al-Saleh, Ayman; Fu, Yuan; Teoh, Kevin

doi:10.1111/j.1537-2995.2012.03958.x

Cited by 9 publications

(4 citation statements)

References 25 publications

(49 reference statements)

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“…This study demonstrated no effect of ultrafiltration on the transfusion of homologous blood, postoperative haemorrhage or discharge Hb. 357 In contrast to this study, another prospective RCT in 573 patients receiving ultrafiltration at the end of CPB (treatment) or no ultrafiltration (control) showed a lower prevalence of early morbidity [66 of 284 (23.2%) vs 117 of 289 (40.5%); P ¼ 0.0001] and lower blood transfusion requirements (1.66 ± 2.6 vs 2.25 ± 3.8 U/patient; P ¼ 0.039) in the ultrafiltration group. 297 In a similar, smaller RCT (60 patients), also comparing ultrafiltration to no ultrafiltration at the end of CPB, ultrafiltration was associated with increased inflammatory response, reduced chest tube drainage (598 ± 123 ml vs 848 ± 455 ml; P ¼ 0.04) and fewer blood transfusions (0.6 ± 0.6 U/patient vs 1.6 ± 1.1 U/patient; P ¼ 0.03).…”

Section: Iib Cmentioning

confidence: 99%

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Kunst

Milojevic

Boer

et al. 2019

British Journal of Anaesthesia

127

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Special Article responsible in the event of any contradiction, discrepancy and/or ambiguity between the EACTS, EACTA and EBCP Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS, EACTA and EBCP Guidelines fully into account when exercising their clinical judgement as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS, EACTA and EBCP Guidelines do not, in any way whatsoever, override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the EACTS, EACTA and EBCP Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. The article has been co-published with permission in the British Journal of Anaesthesia, the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery.

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Section: Iib Cmentioning

confidence: 99%

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

Kunst

Milojevic

Boer

et al. 2019

British Journal of Anaesthesia

127

View full text Add to dashboard Cite

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“…However, a study in CABG patients by Whitlock et al showed no benefit in reducing blood loss or allogeneic transfusions when post-CPB hemoconcentration of circuit contents was applied. 26 A small study of patients undergoing myocardial revascularization examined how MUF and CUF affected intraoperative coagulation and fibrinolytic systems. 27 Other than an increase in antithrombin III levels in the MUF group compared to CUF and control patients, there were no differences in platelet counts, coagulation parameters or fibrinolytic systems.…”

Section: Commentmentioning

confidence: 99%

The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass

et al. 2018

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Background: Ultrafiltration during cardiopulmonary bypass (CPB) reduces fluid overload and inflammatory mediators in open-heart surgery and is thought to reduce the risk of red blood cell (RBC) transfusion. We evaluated its effectiveness in reducing RBC transfusions in a large population undergoing cardiac surgery, among patients in general as well as by gender. Methods: We analyzed 40,650 propensity-matched adult cardiac surgery cases conducted over a 61-month period at 195 hospitals. We assessed the risk of intraoperative transfusion (⩾1 unit RBC) according to body surface area (BSA)-normalized ultrafiltration volume via mixed-effects binary logistic regression. Our statistical model controlled for 12 demographic and operative variables as well as for center level tendencies in ultrafiltration use and intraoperative RBC transfusion. In light of recent findings on gender and risk of transfusion, we also included an interaction effect between gender and ultrafiltration volume (UV). Results: Ultrafiltration was associated with an increased crude rate of RBC transfusion (32.1% vs. 28.1%, p<0.001), but equivalent crude median hematocrit change from first in operating room to nadir on bypass (−11% in both groups, p = 0.133). After controlling for patient, operative and site-level characteristics, we found no statistically significant effect on transfusion rate by volume of ultrafiltrate removed nor did we find statistical support for any gender-specific effect of ultrafiltration. Conclusions: Ultrafiltration is not associated with a reduction of risk of RBC transfusion during cardiac surgery. The use of ultrafiltration as a method for reducing intraoperative RBC transfusion warrants further study.

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“…Several previous studies have compared different processing procedures of RPB (unprocessed, centrifugation, or ultrafiltration), but it is still unclear which one is the best choice. The study by Whitlock et al was the largest ( n = 197) randomized controlled trial and showed no significant difference in postoperative transfusion rate and chest drainage between the ultrafiltration and unprocessed groups. Compared to their study, the RPB was more concentrated with a higher hematocrit in this study (29% in Whitlock’s study vs. 49% in this study), which might yield better results on increase in Hgb.…”

Section: Discussionmentioning

confidence: 99%

Ultrafiltration and reinfusion of residual cardiopulmonary bypass pump blood: A prospective non‐randomized controlled study

2019

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The aim of the study was to investigate whether processing residual pump blood with ultrafiltration could increase the increment of hemoglobin after residual pump blood reinfusion and evaluate its influence on plasma‐free hemoglobin (pFHb) level and postoperative renal function. Sixty adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were assigned to 2 groups, based on pump blood processing strategy: ultrafiltration plus reinfusion (n = 30) or reinfusion (control; n = 30). Increment in hemoglobin and pFHb after reinfusion (ΔHgb, ΔpFHb), reinfusion volume, postoperative chest drainage volume (first 24 h), duration of mechanical ventilation, changes in serum creatinine, and prevalence of AKI were compared between the 2 groups. Higher levels of both ΔHgb and ΔpFHb were observed after reinfusion in the ultrafiltration group [ΔHgb 1.8 ± 1.1 g/dL vs. 1.2 ± 0.6 g/dL, P = 0.03, ΔpFHb 100 (0, 200) mg/L vs. 0 (−100, 0) mg/L, P = 0.03]. The reinfusion volume was lower in the ultrafiltration group [550 (325, 615) mL vs. 1000 (900, 1180) mL, P < 0.001]. No differences were found in postoperative chest drainage volume (first 24 h), duration of mechanical ventilation, changes in serum creatinine, and prevalence of AKI. Compared to the unprocessed group, ultrafiltration before reinfusion of residual pump blood improved the hemoglobin level and reduced volume loading. Despite an increase in pFHb, the processing procedure was not related to postoperative kidney injury.

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Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial

Abstract: Ultrafiltration of residual CPB volume in adults undergoing isolated CABG surgery does not reduce the need for transfusion or bleeding.

Cited by 9 publications

References 25 publications

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery

The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass

Ultrafiltration and reinfusion of residual cardiopulmonary bypass pump blood: A prospective non‐randomized controlled study

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