The effectiveness of acute normolvolemic hemodilution and autologous prime on intraoperative blood management during cardiac surgery

Abstract

Regression results show that the use of ANH will result in the greatest decline in hematocrit values. When combined with AP, higher hematocrits and lower transfusions were seen.

Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

“…It has been reported that the use of autologous priming of the extracorporeal circuit prior to CPB may reduce intraoperative transfusion of RBC. 47,48 This technique is extremely attractive as a blood management tool, but requires that the entire cardiac team be involved to see it successfully applied. When examining its use in the present study, we saw a greater than two-fold use in the DN group as opposed to both other CP techniques (Table 2).…”

Retrograde autologous priming to reduce allogeneic blood transfusion requirements: a systematic review

“…More specifically, the priming a At least one of the following factors which affect fluid balance was not taken into account or documented: type and/or dosage of cardioplegia used, the mean arterial blood pressure target during CPB, the use of autotransfusion, the use of hemofiltration, intraoperative blood loss, and the patients' weight/length/body mass index, and/or the transfusion trigger. 26 Nanjappa et al 27 Ševerdija et al 24 Stammers et al 28 Trapp et al 18 Vandewiele et al 29 1 26 Nanjappa et al 27 Ševerdija et al 24 Stammers et al 28 Trapp et al 18 Vandewiele et al 29 10 At least one of the following factors which affect fluid balance were not taken into account or documented: type and/or dosage of cardioplegia used, the mean arterial blood pressure target during CPB, the use of autotransfusion, the use of hemofiltration, intraoperative blood loss, and the patients' weight/length/body mass index, and/or the transfusion trigger. volumes in the RAP groups were significantly higher in the studies that concluded RAP was not beneficial in terms of lowering blood transfusions (Mann-Whitney U test, median priming volume in RAP groups 1,131 vs. 748 mL, p = 0.036).…”

“…Kearsey et al 26 Nanjappa et al 27 Ševerdija et al 24 Stammers et al 28 Trapp et al 18 Vandewiele et al 29 1 groups. Moreover, it is possible that patient management strategies in these three studies did not allow for using lower priming volumes, resulting in the inability to find a significant difference in blood transfusion rate between the RAP and control groups.…”

“…In the study by Stammers et al, 28 the SpecialtyCare Operative Procedure rEgistry (SCOPE) was used, analyzing data from 171 hospitals throughout the United States, of which 12,677 patients undergoing cardiac surgery with RAP and 2,221 patients undergoing surgery without blood conservation strategies. A significantly lower intraoperative transfusion rate was noted in patients undergoing RAP compared to those who did not.…”

“…Eight studies aiming at determining whether the use of RAP during CPB is beneficial in terms of minimizing PRBC requirements were included. Five studies, of which one randomized 19 and four observational studies, 18 , 24 , 28 , 29 reported a significant difference in PRBC transfusion in favor of the RAP group. All studies used the number of intraoperative transfusions per patient or the proportion of patients receiving intraoperative transfusions as an outcome measure.…”