Abstract
Compare the use of blood products and intravenous fluid management in patients scheduled for coronary artery bypass surgery and randomized to minimal invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC). A total of 240 patients who were scheduled for their first on-pump CABG, were randomized to MiECC or CECC groups. The study period was the first 84 hours after surgery. Hemoglobin <80 g/l was used as transfusion trigger. Red blood cell transfusions intraoperatively were given less often in the MiECC group (23.3% vs 9.2%, p = 0.005) and the total intravenous fluid intake was significantly lower in the MiECC group (3300 ml [2950-4000] vs 4800 ml [4000-5500], p < 0.001). Hemoglobin drop also was lower in the MiECC group (35.5 ± 8.9 g/l vs 50.7 ± 9 g/l, p < 0.001) as was hemoglobin drop percent (25.3 ± 6% vs 35.3 ± 5.9%, p < 0.001). Chest tube drainage output was higher in the MiECC group (645 ml [500-917.5] vs 550 ml [412.5-750], p = 0.001). Particularly, chest tube drainage in up to 600 ml category, was in benefit of CECC group (59.1% vs 40.8%, p = 0.003). ROC curve analysis showed that patients with hemoglobin level below 95 g/l upon arrival to intensive care unit was associated with increased risk of developing postoperative atrial fibrillation (POAF) (p = 0.002, auc = 0.61, cutoff <95, sensitivity = 0.47, positive predictive value = 0.64). MiECC reduced the intraoperative need for RBC transfusion and intravenous fluids compared to the CECC group, also reducing hemoglobin drop compared to the CECC group in CABG surgery patients. Postoperative hemoglobin drop was a predictor of POAF.
Highlights
A majority of the coronary artery bypass operations (CABG) are performed with the assistance of extracorporeal circulation
The number of patients receiving RBC transfusion in operating theater was significantly lower in minimal invasive extracorporeal circulation (MiECC) group compared to conventional extracorporeal circulation (CECC) group (23.3% vs 9.2%, p = 0.005, respectively) (Table 2)
After the onset of perfusion, hemoglobin drop (35.5 ± 8.9 g/l vs 50.7 ± 9 g/l, p < 0.001, respectively) and hemoglobin drop percent (25.3 ± 6% vs 35.3 ± 5.9%, p < 0.001, respectively) were significantly lower in the MiECC group compared to the CECC group (Table 2, Figure 1)
Summary
A majority of the coronary artery bypass operations (CABG) are performed with the assistance of extracorporeal circulation. The most used method is the conventional extracorporeal circulation (CECC). CECC is known to be associated with undesirable side-effects such as hemodilution, increased systemic inflammatory response, and activated coagulation cascade. Hemodilution is the main reason for the use of blood products in cardiac surgery and per se is considered an independent risk factor for increased mortality and major morbidity.[1,2,3,4,5,6]. Evolution of the cardiopulmonary bypass has emerged new techniques such as minimal invasive extracorporeal circulation (MiECC). The principle behind MiECC is to reduce hemodilution and reduced blood-air and blood-artificial material contact by using centrifugal pump driven, coated, closed, and minimized circuit without open venous reservoir. Concept has theoretical benefits and evidence supporting its use.[7]
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