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

Abstract

Cardiopulmonary bypass (CPB) requirement in infants presents a unique challenge because of the large prime volume‐to‐blood volume ratio. Packed red blood cells (PRBCs) tend to deteriorate with long‐term storage owing to their unphysiological composition and osmolality. Given that blood priming is inevitable in neonates, it is suggested that the metabolic load and osmolality are diminished before CPB initiation. We conducted the present study to test the hypothesis that the zero‐balance ultrafiltration (Z‐BUF) of the priming blood with 0.45% saline might be sufficient for modifying the metabolic load and osmolality and, thus, achieving a physiological state. Sixty infants with a weight below 10 kg undergoing CPB were randomly assigned either to a control group or to a Z‐BUF group and the Z‐BUF of the priming blood was performed in the latter group. Electrolytes and osmolality were measured in the priming blood. The bleeding volume, the blood transfusion rate, the length of mechanical ventilation, the length of stay in the intensive care unit (ICU), the body temperature, and renal biomarkers were compared between the 2 groups. The osmolality and the levels of potassium, sodium, glucose, chloride, and lactate in the priming blood were significantly decreased after Z‐BUF (P < .01). The Z‐BUF group showed significant reductions in postoperative blood loss; postoperative blood transfusion; time to extubation; the length of stay in the ICU; the levels of lactate, sodium, and blood urea nitrogen at 24 hours postoperatively and the body temperature at 18 hours postoperatively (P < .05). However, no statistically significant differences were found between the 2 groups regarding the body temperature and the levels of serum creatinine and blood urea nitrogen after admission to the ICU. The results of the present study demonstrated that the Z‐BUF of the priming blood could be a useful strategy in infants undergoing CPB insofar as it significantly modified the composition of the priming blood and improved the clinical outcome among our patients.

Benefícios Da Técnica De Ultrafiltração Com Balanço Zero (Z-Buf) Durante a Circulação Extracorpórea Em Pacientes Submetidos À Cirurgia Cardíaca

“…Corroborando os dados encontrados, Zhou e colaboradores reportaram que níveis de glicose, lactado e TNF-α no sangue do prime foram significativamente menores no grupo onde foi utilizada Z-BUF em relação ao grupo controle (ZHOU et al, 2013) GARG et al, 2017;KEIDAN et al, 2004). Nesse estudo, foi demonstrado que a Z-BUF do sangue homólogo do prime foi responsável por diminuir o nível de lactato sérico, bem como também se apresentou reduzido no momento da admissão na UTI (GHOLAMPOUR et al, 2020).…”

“…Foi demonstrado que a osmolalidade pós-intervenção com Z-BUF do sangue do prime atingiu o nível fisiológico de 290 mOsm/kg (279-300 mOsm/kg), enquanto a osmolalidade do sangue do prime foi de 319 mOsm/kg (315-335 mOsm/kg) no grupo controle. Esse achado pode ser atribuído à redução da concentração de fatores importantes como sódio e glicose (GHOLAMPOUR et al, 2020).…”