Ultrafiltration of Priming Blood Before Cardiopulmonary Bypass Attenuates Inflammatory Response and Maintains Cardiopulmonary Function in Neonatal Piglets

Abstract

Blood priming is necessary for cardiopulmonary bypass (CPB) in neonates to avoid excessive hemodilution; however, transfusion-related inflammation affects postCPB outcomes in neonatal open-heart surgery. We hypothesized that ultrafiltration of priming blood before CPB may reduce inflammatory mediators in priming blood and postCPB inflammatory responses, thereby improving cardiopulmonary function. Twelve 1-week-old piglets (3.5 +/- 0.2 kg) were divided into two groups. Group U (n = 6) employed the priming blood ultrafiltrated before CPB, but group N (n = 6) used the nonultrafiltrated blood. Cardiopulmonary bypass was performed for 2 hours and then modified ultrafiltration (MUF) was conducted. Data were acquired before CPB and after MUF. The values of K+, serotonin, and IL-8 in priming blood was significantly decreased after ultrafiltration (8.2 +/- 2.6 vs. 4.2 +/- 0.8 mEq/L, p < 0.01, 234 +/- 96 vs. 74 +/- 42 ng/ml, p < 0.01, 78.4 +/- 5.1 vs. 64.5 +/- 59.1 pg/ml, p < 0.05). Group U after MUF had lower thrombin-antithrombin complex levels (23.9 +/- 5.1 vs. 33.7 +/- 4.6 ng/ml, p < 0.01) and lower IL-8 levels in airway fluid (925 +/- 710 vs. 2495 +/- 1207 pg/ml, p < 0.05) than group N. Cardiac output and arterial PO2 after MUF in group U were also higher (1.13 +/- 0.21 vs. 0.69 +/- 0.22, p < 0.01, 340 +/- 190 vs. 149 +/- 84 mm Hg, p < 0.05). The ultrafiltration of blood priming before CPB attenuated activation of the coagulation pathway and inflammatory responses and preserved cardiopulmonary function in neonatal piglets.

Managing the inflammatory response after cardiopulmonary bypass: review of the studies in animal models

“…Two studies sought to investigate whether changes in priming would lead to changes in the inflammatory response and the microcirculation after the use of CPB. Ugaki et al [ 23 ] demonstrated that the filtration of blood perfusate prior to the commencement of CPB reduces the formation of IL-8 and thrombin-antithrombin complex, in addition to increase the PaO 2 . Farstad et al [ 24 ] , in turn, investigated the use of iso-oncotic solutions of hetastarch and albumin as perfusate, demonstrating that both significantly reduce tissue edema when compared to commonly used perfusate solution.…”

Residual blood processing by centrifugation, cell salvage or ultrafiltration in cardiac surgery

“…There are no clinical studies available evaluating the effects of ultrafiltration or centrifugation on prothrombin fragment or TAT levels in residual blood volumes. One study in piglets showed that ultrafiltration of priming blood may reduce TAT levels, but to a lower extent when compared to cell salvage [25]. This is likely to be explained by the larger residual plasma volume present after ultrafiltration as compared to cell salvage.…”

Zero‐balance ultrafiltration of the priming blood modifies the priming components and improves the clinical outcome in infants undergoing cardiopulmonary bypass: A randomized controlled trial

“…Zhou et al 7 reported that the levels of glucose, lactate, and tumor necrosis factor in the priming blood were significantly less in their ultrafiltration group than in their control group, while the level of potassium was the same in both groups. Elsewhere, a study by Ugaki et al 8 illustrated that the ultrafiltration of the priming blood led to a signifi cant drop in the levels of potassium, lactate, serotonin, and interleukin-8 in the priming blood solution, while the level of sodium was not modified. Rapid and massive transfusions of the priming blood may lead to hyperkalemia, cardiac arrhythmias, and cardiac arrest and acute hypernatremia-induced brain shrinkage may result in intracranial hemorrhage and venous thrombosis.…”