The Failure of Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit to Reduce Blood Use After Cardiac Surgical Procedures

Murphy, Glenn S.; Szokol, Joseph W.; Nitsun, Martin; Alspach, David; Avram, Michael J.; Vender, Jeffery S.; Votapka, Timothy V.; Rosengart, Todd K.

doi:10.1213/01.ane.0000112306.71113.5e

Cited by 48 publications

(44 citation statements)

References 11 publications

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“…That study concluded that there was no clinical effectiveness in the use of RAP. 12 Our study showed that there was a significant difference in pump priming volumes, which is to be expected when comparing a RAP with a non-RAP procedure, but there was no difference in transfusion rate between RAP and non-RAP patients. Interestingly, there was a significant difference in the on-CPB Hb levels (RAP 9.1g/dl vs non-RAP 7.7g/dl, p<0.001), which may confer an advantage in postoperative recovery to the RAP group.…”

Section: Discussionsupporting

confidence: 50%

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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Section: Discussionsupporting

confidence: 50%

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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“…Although recent isolated studies confirm the benefits of recent RAP [13], at least two studies in meta-analysis are not favorable [14,15]. These results suggest that overall.…”

Section: Discussionmentioning

confidence: 81%

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Reges¹,

Vicente²,

Rodrigues³

et al. 2011

Rev Bras Cir Cardiovasc

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Introduction: Retrograde autologous priming (RAP) is a cardiopulmonary bypass (CPB) method, at low cost. Previous studies have shown that this method reduces hemodilution and blood transfusions needs through increased intraoperative hematocrit.Objective: To evaluate RAP method, in relation to standard CPB (crystalloid priming), in adult patients.Methods: Sixty-two patients were randomly allocated to two groups: 1) Group RAP (n = 27) of patients operated using the RAP and; 2) Control group of patients operated using CPB standard crystalloid method (n = 35). The RAP was performed by draining crystalloid prime from the arterial and venous lines, before CPB, into a collect recycling bag. The main parameters analyzed were: 1) CPB hemodynamic data; 2) Hematocrit and hemoglobin values; 3) The need for blood transfusions.Results: It was observed statistically significant fewer transfusions during surgery and reduced CPB hemodilution using RAP. The CPB hemodynamic values were similar, observing a tendency to use lower CPB flows in the RAP group patients.Conclusion: This investigation was designed to be a small-scale pilot study to evaluate the effects of RAP, which were demonstrated concerning the CPB hemodilution and blood transfusions.

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“…The efficacy of RAP in adult patients is still controversial and has not yet been reported in children. 19,20 …”

Section: Retrograde Autologous Blood Priming (Rap)mentioning

confidence: 99%

Blood Conservation in Pediatric Cardiac Surgery

Pouard

2005

Transfus Alt Transfus Med

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The Failure of Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit to Reduce Blood Use After Cardiac Surgical Procedures

Abstract: Priming of the cardiopulmonary bypass circuit with the patients' own blood (retrograde autologous priming) resulted in insignificant reductions in blood use in a large, unselected group of patients undergoing cardiac surgical procedures.

Cited by 48 publications

References 11 publications

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

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

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Blood Conservation in Pediatric Cardiac Surgery

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