Zero‐Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and Improves the Respiratory Function in Infants After Cardiopulmonary Bypass: A Randomized Controlled Trial

Abstract

Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and infants to avoid exceeding hemodilution; however, transfusion-related inflammation affects post-CPB outcomes in infant open-heart surgery. Procalcitonin, a newly detected inflammatory moderator and a sensitive parameter for predicting pulmonary dysfunction secondary to CPB, rises after CPB. We hypothesized that the hemofiltration of priming blood before CPB might decrease inflammatory mediators in the blood and post-CPB inflammatory replications, thereby improving the respiratory function after CPB in infants. Sixty infants with a weight below 10 kg were divided randomly into two equal groups of CPB with the zero-balance ultrafiltration (Z-BUF) of priming blood and CPB without it. The procalcitonin level was measured before anesthesia, after admission to the intensive care unit (ICU), and 24 h afterward. The respiratory index and pulmonary compliance were measured after anesthesia, at the end of CPB, and 2 h after admission to the ICU. Additionally, time to extubation was recorded. The Z-BUF of priming blood maintained electrolytes within a physiologic level, and procalcitonin had a slighter rise in the Z-BUF Group at 24 h after admission to the ICU (P = 0.05). The respiratory index was decreased in the Z-BUF Group, but the difference with the control group did not reach statistical significance (P > 0.05). The change in pulmonary compliance was significantly increased in the cyanotic patients in the intervention group, but there was no significant difference between the two groups. The time to extubation and the ICU stay were shorter in the Z-BUF Group (P < 0.05). A positive correlation was found between the peak procalcitonin concentration and the time to extubation directly and pulmonary compliance reversely. These results suggest that the Z-BUF of priming blood may have some beneficial clinical effects such as improved respiratory function and attenuated procalcitonin.

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

“…The volumes of blood transfusion and bleeding were significantly lower in the Z‐BUF group than in the control group ( P = .001). The postoperative mechanical ventilation time was significantly low in the Z‐BUF group by comparison with the control group ( P = .03), and there was a statistically significant difference as regards the length of stay at the ICU between the 2 groups ( P = .02) …”

“…Our results revealed that the amounts of bleeding and blood transfusion were lower in the Z‐BUF group than in the control group. Gholampour et al reported that the ultrafiltration of stored blood before CPB was able to lessen the unfavorable effects of the stored blood and the production of inflammatory cytokines, which in turn significantly shortened the length of stay at the ICU and the duration of ventilation in their pediatric patients . It is worthy of note, however, that the method of ultrafiltration used by Shimpo and colleagues was hemofiltration rather than CUF.…”

“…It is inevitable to use banked blood for priming to avoid hemodilution and preserve adequate oxygen delivery in infants. The priming blood encompasses high levels of potassium, sodium, glucose, lactate, and osmolality . Preservation of RBCs in citrate‐phosphate‐dextrose (CPD)‐buffered and saline‐adenine‐glucose‐mannitol (SAG‐M) solutions lead to affect electrolyte and osmolarity disorders .…”

“…It is, therefore, proposed that the composition of the ultimate prime is modified to the physiological range before the onset of CPB. Zero‐balance ultrafiltration (Z‐BUF) decreases the concentration of inflammatory mediators and normalizes the concentration of electrolytes and the combination of ultrafiltration by the zero‐balance ultrafiltration of priming blood, and conventional bypass method effectively reduces the side effects of CPB . Normal saline is not an ideal substitution fluid as a result of its high chloride content …”

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“…Maziar Gholampour Dehaki et al of the Rajaie Cardiovascular, Medical & Research Center—Perfusion, Tehran, Iran reported in a randomized controlled trial that zero‐balance ultrafiltration of priming blood attenuates procalcitonin and improves respiratory function in infants after CPB. Sixty infants were divided randomly into two equal groups of CPB with the zero‐balance ultrafiltration (Z‐BUF) of priming blood and CPB without it.…”