Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery

Balachandran, S.; Cross, Mervyn J.; Karthikeyan, Subramanian; Mulpur, A; Hansbro, S.D.; Hobson, Peter

doi:10.1016/s0003-4975(02)03513-0

Cited by 77 publications

(54 citation statements)

References 19 publications

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“…Patients in the RAP group had a higher haematocrit on bypass and fewer patients needed transfusion of PRBC, which is in accordance with findings by other investigators [7][8][9][10][11][12][13] . Although the NON-RAP group counted more female patients, who have a predetermined higher transfusion risk as compared to male patients, both bivariate and multivariate logistic regression analysis indicated a prominent effect of RAP on transfusion of PRBC.…”

Section: Discussionsupporting

confidence: 91%

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

et al. 2011

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The hypothesis was tested whether retrograde autologous priming (RAP) of the cardiopulmonary bypass system, compared to a standard primed system (NON-RAP group), results in less haemodilution and less transfusion of packed red blood cells. Retrospectively, data was collected from the medical charts of one hundred patients undergoing elective coronary artery bypass grafting using cardiopulmonary bypass. Fifty patients where RAP was used have been compared to fifty patients using NON-RAP. The prime volume in the NON-RAP group was 1,627±108 mL versus 782±96 mL in the RAP group (p<0.001). The lowest haematocrit during perfusion was 22% in the NON-RAP group versus 26% when the RAP technique was used (p<0.001). In the NON-RAP group, 26% of the patients received packed red cells in contrast to 6% in the RAP group (p<0.012). A positive association was found between RAP and less transfusion of packed red blood cells (p<0.012). In conclusion, retrograde autologous priming, reducing the prime volume of the cardiopulmonary bypass system, causes less haemodilution and reduces intraoperative transfusion of packed red blood cells.

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Section: Discussionsupporting

confidence: 91%

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

et al. 2011

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“…The meta-analysis 8 of the six randomised controlled trials [2][3][4][5][6][7] investigating RAP showed a 64% reduction (odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.13-0.94, p=0.04) in the need for the use of blood intraoperatively and a 74% reduction (OR: 0.26, 95% CI: 0.13-0.52, p=0.0001) in the need for blood during a hospital stay. The mean intraoperative fluid balance was not significantly different in RAP patients (1,574.6ml) compared with the control groups (2,016.2ml) (p=0.44).…”

Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts

Kearsey

Thekkudan

Robbins

et al. 2013

annals

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INTRODUCTION Currently, around 35-80% of patients undergoing cardiac surgery in the UK receive a blood transfusion. Retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit has been suggested as a possible strategy to reduce blood transfusion during cardiac surgery. METHODS Data from 101 consecutive patients undergoing isolated coronary artery bypass grafts (where RAP was used) were collected prospectively and compared with 92 historic patients prior to RAP use in our centre. RESULTS Baseline characteristics (ie age, preoperative haemoglobin [Hb] etc) were not significantly different between the RAP and non-RAP groups. The mean pump priming volume of 1,013ml in the RAP group was significantly lower (p<0.001) than that of 2,450ml in the non-RAP group. The mean Hb level at initiation of bypass of 9.1g/dl in patients having RAP was significantly higher (p<0.001) than that of 7.7g/dl in those who did not have RAP. There was no significant difference between the RAP and non-RAP groups in transfusion of red cells, platelets and fresh frozen plasma, 30-day mortality, re-exploration rate and predischarge Hb level. The median durations of cardiac intensive care unit stay and in-hospital stay of 1 day (interquartile range [IQR]: 1-2 days) and 5 days (IQR: 4-6 days) in the RAP group were significantly shorter than those of the non-RAP group (2 days [IQR: 1-3 days] and 6 days [IQR: 5-9 days]). CONCLUSIONS In the population group studied, RAP did not influence blood transfusion rates but was associated with a reduction in duration of hospital stay.

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“…To undertake such a protocol is both medically justified and feasible. The restraining factor in the implementation of such a protocol is cost, as the proposed blood conservation protocol relies upon two medications: aprotinin and EPO [3,24]. Hence, the cost-benefit analysis depends primarily on the price of EPO.…”

Section: ) Legal and Ethical Aspects Of Non Transfusionmentioning

confidence: 99%

Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah's Witnesses: a Comparative Study with Non-Jehovah's Witnesses

Kim

Lee

2016

Korean J Crit Care Med

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Background: Refusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients.

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Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery

Cited by 77 publications

References 19 publications

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts

Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah's Witnesses: a Comparative Study with Non-Jehovah's Witnesses

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