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Gupta S, McEwen C, Basha A, Panchal P, Eqbal A, Wu N, Belley-Cote EP, Whitlock R. Retrograde autologous priming in cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 60:1245-1256. [PMID: 34417595 DOI: 10.1093/ejcts/ezab334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/01/2021] [Accepted: 06/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Guidelines recommend retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit. However, the efficacy and safety of RAP is not well-established. We performed a systematic review and meta-analysis to determine the effects of RAP on transfusion requirements, morbidity and mortality. METHODS We searched Cochrane Central Register of Controlled Trials, Medline, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature and Embase for randomized controlled trials (RCTs) and observational studies comparing RAP to no-RAP. We performed title and abstract review, full-text screening, data extraction and risk of bias assessment independently and in duplicate. We pooled data using a random effects model. RESULTS Twelve RCTs (n = 1206) and 17 observational studies (n = 3565) were included. Fewer patients required blood transfusions with RAP [RCTs; risk ratio 0.58 [95% confidence interval (CI): 0.51, 0.65], P < 0.001, and observational studies; risk ratio 0.65 [95% CI: 0.53, 0.80], P < 0.001]. The number of units transfused per patient was also lower among patients who underwent RAP (RCTs; mean difference -0.38 unit [95% CI: -0.72, -0.04], P = 0.03, and observational studies; mean difference -1.03 unit [95% CI: -1.76, -0.29], P < 0.006). CONCLUSIONS This meta-analysis supports the use of RAP as a blood conservation strategy since its use during cardiopulmonary bypass appears to reduce transfusion requirements.
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Affiliation(s)
- Saurabh Gupta
- Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Charlotte McEwen
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ameen Basha
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Puru Panchal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Adam Eqbal
- Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Wu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Cote
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Whitlock
- Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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2
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Basylev VV, Evdokimov ME, Pantyukhina MA. [Gastrointestinal complications after on-pump cardiac surgery]. Khirurgiia (Mosk) 2021:39-48. [PMID: 34363444 DOI: 10.17116/hirurgia202108139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the incidence and independent predictors of gastrointestinal complications (GICs) following on-pump cardiac surgery. MATERIAL AND METHODS We retrospectively analyzed data of 9559 adults who underwent cardiac surgery in 2012-2017. Two groups of patients were distinguished: group 1 - 47 (0.5%) patients with abdominal complications followed by urgent surgery; group 2 - 9512 (95.5%) patients without complications or effective therapy. CONCLUSION 1. Predictors of gastrointestinal complications: age >65 years, previous AF (p=0.011) and multifocal atherosclerosis (p=0.016), LV EF <40% (p=0.039), aortic cross-clamping time > 90 min (p=0.021), intraoperative blood loss over 600 ml (p=0.002), postoperative serum creatinine >140 μmol/l (p=0.005), mechanical ventilation >24 hours (p=0.023). 2. Reduced hemodilution during CPB, warm blood cardioplegia, higher perioperative values of Hb, Ht and IDO2 during cardiopulmonary bypass can prevent ischemic injury of abdominal organs during prolonged cardiac surgery.
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Affiliation(s)
- V V Basylev
- Federal Center for Cardiovascular Surgery, Penza, Russian Federation
| | - M E Evdokimov
- Federal Center for Cardiovascular Surgery, Penza, Russian Federation
| | - M A Pantyukhina
- Federal Center for Cardiovascular Surgery, Penza, Russian Federation
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3
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Hensley NB, Gyi R, Zorrilla-Vaca A, Choi CW, Lawton JS, Brown CH, Frank SM, Grant MC, Cho BC. Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis. Anesth Analg 2021; 132:100-107. [PMID: 32947294 DOI: 10.1213/ane.0000000000005151] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients. METHODS This study involved a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of RAP in cardiac surgery involving CPB. The primary outcome was intraoperative allogeneic red cell transfusion. Secondary outcomes included whole hospital allogeneic transfusions and adverse events such as acute kidney injury (AKI) and stroke. RESULTS A total of 11 RCTs (n = 1337 patients) were included, comparing RAP patients (n = 674) to control (n = 663). In addition, 10 observational studies (n = 2327) were included, comparing RAP patients (n = 1257) to control (n = 1070). Overall, RAP was associated with a significantly reduced incidence of intraoperative red cell transfusion (n = 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI], 0.22-0.55, P < .001) compared to controls. This effect was seen among RCTs (n = 10 studies; OR = 0.19; 95% CI, 0.08-0.45, P < .001) and observational studies (n = 8 studies; OR = 0.66; 95% CI, 0.50-0.87, P = .004) in isolation. RAP was also associated with a significantly reduced incidence of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI, 0.19-0.41, P < .001). Among the studies that reported AKI and stroke outcomes, there was no statistically significant increased odds of AKI or stroke in either RAP or control patients. CONCLUSIONS Based on the pooled results of the available literature, RAP is associated with a significant reduction in intraoperative and whole hospital allogeneic red cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical patients and thus, lessen transfusions. Additional high-quality prospective studies are necessary to determine the ideal priming volume necessary to confer the greatest benefit without incurring organ injury.
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Affiliation(s)
- Nadia B Hensley
- From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Richard Gyi
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | | | - Chun W Choi
- Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer S Lawton
- Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles H Brown
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Steve M Frank
- From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael C Grant
- From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brian C Cho
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
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Vranken NP, Babar ZU, Montoya JA, Weerwind PW. Retrograde autologous priming to reduce allogeneic blood transfusion requirements: a systematic review. Perfusion 2020; 35:574-586. [PMID: 32009539 PMCID: PMC7536507 DOI: 10.1177/0267659119895474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Efforts have been made to minimize transfusion of packed red blood cells in
patients undergoing cardiac surgery with cardiopulmonary bypass. One method
concerns retrograde autologous priming. Although the technique has been used
for decades, results remain contradictory in terms of transfusion
requirements. Objective: This systematic literature review aimed to summarize the evidence for the
efficacy of retrograde autologous priming in terms of decreasing
perioperative packed red blood cell requirements in adults. Methods: Two researchers independently searched PubMed for articles published in the
past 10 years. The modified Cochrane collaboration Risk of Bias Tool and the
Research Triangle Institute Item Bank were used to assess bias. Results: Eight studies were included, of which two randomized and six observational
studies. Five studies, including one randomized study, report a significant
decrease in packed red blood cell use in the retrograde autologous priming
group compared to no retrograde autologous priming used. All studies are
flawed by at least a high risk bias of bias score on one item of the bias
assessment. Conclusion: Although most studies reported significantly fewer packed red blood cell
transfusions in the retrograde autologous priming group, it is important to
note that relatively few articles are available which are flawed by several
types of bias. Prospective, randomized multi-center trials are warranted to
conclude decisively on the benefits of retrograde autologous priming.
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Affiliation(s)
- Nousjka Pa Vranken
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Zaheer Ud Babar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jesse A Montoya
- Perfusion Sciences Program, Department of Pharmacology, The University of Arizona, Tucson, AZ, USA
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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5
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Rafiee M, Toutounchi MZ, Yazdani R, Mohammadi N. Effect of Retrograde Autologous Priming on Clinical Outcome of Cardiopulmonary Bypassing on Patients Undergoing Coronary Artery bypass Grafting. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2019. [DOI: 10.29252/ijcp-26691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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6
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Basylev VV, Evdokimov ME, Pantyuhina MA, Kokushkin MV. Is there any connection between method of priming extracorporeal circuit and cerebral oximetry results? ACTA ACUST UNITED AC 2019. [DOI: 10.33667/2078-5631-2019-1-16(391)-22-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives. To compare the influence of different priming techniques on cerebral oximetry results during CPB in adult patients.Methods. This study is a single-center retrospective review of data collected from adult patients who underwent isolated CABG with CPB between January and December, 2016. The patients were divided into two standardized groups with the sole difference between them being the method of priming CPB circuit: the first one was the group where we used our modified retrograde method of priming (n = 45) and the second one was the group with standard priming (n = 45). Hematocrit, hemoglobin, cerebral oxygenation were evaluated at the following points: beginning of the operation, start of CPB, cross clamping, 15, 30, 45 minutes and the end of CPB and the end of operation.Results. In the first group indices of cerebral oximetry were higher comparing to the second group at list of the 45 minutes of CPB (р < 0,001). For the first 15 minutes of CPB hematocrit was also higher in the first group. Priming volume and the need for blood transfusion or ultrafiltration were also smaller in the first group.Conclusion. Modified priming technique allows to maintain higher indices of cerebral oximetry, decreases volume overload and the need for blood transfusion comparing to standard technique.
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7
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Hofmann B, Kaufmann C, Stiller M, Neitzel T, Wienke A, Silber RE, Treede H. Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial. J Cardiothorac Surg 2018; 13:50. [PMID: 29784004 PMCID: PMC5963082 DOI: 10.1186/s13019-018-0739-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/10/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Adult cardiac surgery with extracorporeal circulation is known to be associated with increased risk of blood transfusion leading to adverse outcomes. Procedures like retrograde autologous priming (RAP) may reduce these negative side effects. This randomized prospective study was initiated to assess whether RAP using specifically designed RAP bag (Terumo) has immediate effects on patient outcome. METHODS One hundred eighteen adults undergoing elective CABG or elective aortic valve replacement were randomly assigned by a computer program into two groups: the RAP group (n = 54) in which the retrograde autologous priming was applied and the non-RAP (n = 64) group in which the same setting was used without the possibility to save priming volume. Patient demographics, preoperative characteristics and postoperative outcomes were analyzed for both groups. RESULTS The primary endpoint defined as rate of intraoperative blood transfusion was significantly reduced in the RAP-group (p = 0.04). The absolute risk reduction for RAP managed patients was 13.5 percent points. There were no significant differences in operation time and blood loss. No deaths and no myocardial infarctions were observed. The number of patients needed to treat to prevent at least one red blood cell transfusion was around 8 (NNT = 7.42). CONCLUSIONS Retrograde autologous priming is a safe and less invasive procedure which achieves clear benefits for adult cardiac surgery patients. In the light of increasing red blood cell transfusion risks and costs and the wish of patients to avoid a transfusion implementation of retrograde autologous priming is an interesting option. TRIAL REGISTRATION German Clinical Trials Register ID: DRKS00013512 , registered 04 December 2017.
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Affiliation(s)
- Britt Hofmann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Claudia Kaufmann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Markus Stiller
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Thomas Neitzel
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, 06097 Halle, Germany
| | - Rolf-Edgar Silber
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
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8
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Sebastian R, Ratliff T, Winch PD, Tumin D, Gomez D, Tobias J, Galantowicz M, Naguib AN. Revisiting acute normovolemic hemodilution and blood transfusion during pediatric cardiac surgery: a prospective observational study. Paediatr Anaesth 2017; 27:85-90. [PMID: 27734554 DOI: 10.1111/pan.13014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The majority of allogeneic transfusions occur in the perioperative setting, especially during cardiac surgery. In addition to the economic implications, there is emerging evidence that blood transfusion may increase both morbidity and mortality. Acute normovolemic hemodilution (ANH) may limit the need for blood products. OBJECTIVES The primary objective of this study was to determine if the method of blood collection (syringe or bag) during the ANH process impacted the platelet count and function. The secondary objectives included the need for perioperative blood transfusions during the procedure and in the intensive care unit. In addition, we assessed these outcomes' associations with ANH parameters including the method of collection, time of storage, and volume removed. METHODS Data were collected prospectively from 50 patients undergoing cardiac surgery on cardiopulmonary bypass over a 6-month period. Platelet count and function were measured for the ANH blood immediately after collection and again prior to transfusing to the patient at the end of cardiopulmonary bypass. Other data collected included ANH volume, length of storage, and the quantity of all blood products given throughout the perioperative period. RESULTS No change in platelet count or function was noted regardless of the length of time or collection method for the ANH blood. Twenty-three patients received blood or blood products in the operating room or the intensive care unit, while 27 patients received no blood transfusion during their entire hospitalization. Higher ANH volume (ml·kg-1 ) and longer storage time were associated with a greater need for intraoperative transfusions. CONCLUSION Acute normovolemic hemodilution protects the platelets from the untoward effects of cardiopulmonary bypass and offers an important autologous blood product that improves hemostasis at the conclusion of surgery. Platelet count and function are preserved regardless of the method of collection or the length of storage. The volume of ANH removed appears to be an important determinant of blood product use and further understanding of the impact of this variable is a future direction of upcoming prospective research.
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Affiliation(s)
- Roby Sebastian
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Todd Ratliff
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter D Winch
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel Gomez
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Galantowicz
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Aymen N Naguib
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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9
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Kamata M, Stiver C, Naguib A, Tumin D, Tobias JD. A Retrospective Analysis of the Influence of Ventricular Morphology on the Perioperative Outcomes After Fontan Surgery. J Cardiothorac Vasc Anesth 2016; 31:128-133. [PMID: 27720490 DOI: 10.1053/j.jvca.2016.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the effect of ventricular morphology on perioperative outcomes during Fontan surgery. DESIGN Retrospective cohort study. SETTING Single standing, not-for-profit pediatric hospital. PARTICIPANTS A total of 72 patients who underwent Fontan surgery using cardiopulmonary bypass without aortic cross-clamp between January 1, 2009 and December 31, 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The patients were divided into 3 categories depending on their single-ventricle lesions: (1) LV group (n = 20): left dominant and hypoplastic right ventricle; (2) RV group (n = 37): right dominant and hypoplastic left ventricle; and (3) BV group (n = 15): biventricular or indeterminate dominance. Perioperative major adverse events were collected based on the Society of Thoracic Surgeons database. The need for perioperative allogeneic blood transfusions also was determined. The mean age was 3.3±1.7 years and the mean weight was 13.6±4.0 kg. All patients had extracardiac lateral tunnel or conduit Fontan procedures. Sixty-nine of the patients (96%) underwent tracheal extubation in the operating room. Anesthesia, surgery, and CPB times were 326±68, 239±73, and 70±41 minutes, respectively. Eleven patients (15%) required allogeneic blood products intraoperatively, while 30 patients (42%) required allogeneic blood products during the perioperative period. Length of cardiac intensive care unit stay and hospital stay (median [IQR]) were 1 [1,2] and 12 [9,18] days, respectively. There was no mortality and no significant differences between groups in major postoperative complications, anesthetic or surgical variables. CONCLUSIONS No difference in the immediate perioperative outcomes was noted based on ventricular morphology.
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Affiliation(s)
- Mineto Kamata
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
| | - Corey Stiver
- Division of Pediatric Cardiology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Aymen Naguib
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH
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10
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Fu GW, Nie YF, Jiao ZY, Zhao WZ. Clinical applications of retrograde autologous priming in cardiopulmonary bypass in pediatric cardiac surgery. ACTA ACUST UNITED AC 2016; 49:e5138. [PMID: 27119427 PMCID: PMC4849968 DOI: 10.1590/1414-431x20165138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/03/2016] [Indexed: 11/21/2022]
Abstract
Retrograde autologous priming (RAP) has been routinely applied in cardiac pediatric
cardiopulmonary bypass (CPB). However, this technique is performed in pediatric
patients weighing more than 20 kg, and research about its application in pediatric
patients weighing less than 20 kg is still scarce. This study explored the clinical
application of RAP in CPB in pediatric patients undergoing cardiac surgery. Sixty
pediatric patients scheduled for cardiac surgery were randomly divided into control
and experimental groups. The experimental group was treated with CPB using RAP, while
the control group was treated with conventional CPB (priming with suspended red blood
cells, plasma and albumin). The hematocrit (Hct) and lactate (Lac) levels at
different perioperative time-points, mechanical ventilation time, hospitalization
duration, and intraoperative and postoperative blood usage were recorded. Results showed that Hct levels at 15 min after CPB
beginning (T2) and at CPB end (T3), and number of intraoperative blood transfusions
were significantly lower in the experimental group (P<0.05). There were no
significant differences in CPB time, aortic blocking time, T2-Lac value or T3-Lac
between the two groups (P>0.05). Postoperatively, there were no significant
differences in Hct (2 h after surgery), mechanical ventilation time, intensive care
unit time, or postoperative blood transfusion between two groups (P>0.05). RAP can
effectively reduce the hemodilution when using less or not using any banked blood,
while meeting the intraoperative perfusion conditions, and decreasing the
perioperative blood transfusion volume in pediatric patients.
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Affiliation(s)
- G W Fu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y F Nie
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Z Y Jiao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - W Z Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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11
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Naguib AN, Winch PD, Tobias JD, Simsic J, Hersey D, Nicol K, Preston T, Gomez D, McConnell P, Galantowicz M. A single-center strategy to minimize blood transfusion in neonates and children undergoing cardiac surgery. Paediatr Anaesth 2015; 25:477-86. [PMID: 25581204 DOI: 10.1111/pan.12604] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transfusion of blood products in the setting of uncontrolled bleeding is unquestionably lifesaving. However, in many instances, the decision to transfuse is based on physician gestalt rather than medical evidence. When indications for transfusion are unclear, the benefits of blood products must be balanced against their significant risks and associated costs. As our institution is a referral center for patients of Jehovah's Witness faith, this population has pushed our development of techniques to achieve the goal of bloodless surgery. Our practices in caring for this population have become our standard practice for managing all patients undergoing congenital cardiac surgery. OBJECTIVES To evaluate our success in minimizing the use of blood products during pediatric cardiac surgery. METHODS After IRB approval, we retrospectively reviewed all patients who underwent cardiac surgery utilizing cardiopulmonary bypass (CPB), for biventricular repair procedures. The study was conducted at a single institution (Nationwide Children's Hospital (NCH)) during the period: January 1, 2013 and December 31, 2013. RESULTS A total of 209 patients were included. Overall, 81 patients (38.8%) and 81 of 136 (59.6%) weighing more than 6 kg received no blood products (bloodless) during their entire hospital stay. Bloodless surgery was most successful in patients weighing more than 18 kg, followed by patients weighing 6-18 kg. All 73 patients who weighed <6 kg received blood transfusion during their hospitalization. CONCLUSION The techniques that we have developed to initially care for our Jehovah's Witness families may be applied to other pediatric and adult surgical procedures.
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Affiliation(s)
- Aymen N Naguib
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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12
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Tran MH, Lin DM, Wilcox T, Schiro D, Cannesson M, Milliken J. Effects of a multimodality blood conservation schema toward improvement of intraoperative hemoglobin levels and off-pump transfusions in coronary artery bypass graft surgery. Transfusion 2014; 54:2769-74. [DOI: 10.1111/trf.12745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/25/2014] [Accepted: 04/28/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Minh-Ha Tran
- Department of Pathology and Laboratory Medicine; UC Irvine School of Medicine; Irvine California
| | - David M. Lin
- Department of Internal Medicine; UC Irvine School of Medicine; Irvine California
| | | | - Dana Schiro
- Perioperative Services; UC Irvine Medical Center; Irvine California
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Services; UC Irvine School of Medicine; Irvine California
| | - Jeffrey Milliken
- Department of Surgery; UC Irvine School of Medicine; Irvine California
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13
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Sun P, Ji B, Sun Y, Zhu X, Liu J, Long C, Zheng Z. Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis. Perfusion 2013; 28:238-43. [DOI: 10.1177/0267659112474861] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Reducing the priming volume is an effective means of decreasing hemodilution and blood transfusion during cardiopulmonary bypass (CPB). The patient’s own blood was used to replace the crystalloid in the CPB circuit by retrograde autologous priming (RAP) in order to decrease the priming volume. Therefore, we performed a meta-analysis to investigate whether RAP could reduce blood transfusion and improve clinical outcomes. Materials and Methods: A comprehensive search was conducted for randomized, controlled trials (RCTs) exploring RAP in PubMed, Embase, The Cochrane Library, Google Scholar and Chinese literature databases (WanFang, WeiPu and CNKI). Clinical parameters and outcomes were focused on the lowest hematocrit (Hct) during CPB, the number of patients transfused blood intraoperatively, the number of patients transfused blood perioperatively, the number of blood units transfused, 24-hour chest tube drainage, hours to extubation, length of ICU stay, and length of hospital stay. Results: Ten trials, with a total of 1123 patients, were included. The number of patients transfused blood intraoperatively (RR = 0.39, 95% CI = [0.29, 0.53], p<0.00001, I2 = 40%) and perioperatively (RR = 0.53, 95% CI = [0.43, 0.66], p<0.00001, I2 = 0%) and the number of blood units transfused (SMD = -0.53, 95% CI = [-0.73, -0.33], p<0.00001, I2 = 14%) were all significantly reduced in the RAP group. No differences in the hours to extubation (SMD = -0.11, 95% CI = [-0.33, 0.12], p=0.37, I2 = 0%) and the length of ICU stay (SMD = -0.17, 95% CI = [-0.41, 0.08], p=0.18, I2 = 0%) were observed between the two groups. Conclusion: Compared to conventional priming, RAP could reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming. Further studies involving RAP are expected to investigate if this technique is beneficial to the patient.
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Affiliation(s)
- P Sun
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - B Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Y Sun
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - X Zhu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - J Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - C Long
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Z Zheng
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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