Zero balance ultrafiltration using dialysate during nationwide bicarbonate shortage: a retrospective analysis

Ryan Mullane,Tara R Brakke,Lance Fristoe,Helen Mari Merritt-Genore,Troy J Plumb,Nicholas W Markin,Aleem Siddique,Clifford D Miles

doi:10.1186/s13019-019-0986-8

Ryan Mullane, Tara R Brakke + Show 6 more

Open Access

https://doi.org/10.1186/s13019-019-0986-8

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Abstract

BackgroundZero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass.MethodsSingle-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- and post-Z-BUF-D. Secondary outcomes included changes in pre- and post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S).ResultsZ-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure.ConclusionZ-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.

Highlights

Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB)
The “Z-BUF dialysate” group (Z-BUF-D) consisted of all patients undergoing CPB at our single institution in which Z-BUF was performed with dialysate in the first 150 days following switching to the dialysate solution
Forty-six patients underwent CPB with Z-BUF with dialysate (Z-BUF-D) during the first 150 days following the change in Z-BUF protocol

Summary

Introduction

Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). Cardiopulmonary bypass (CPB) can be associated with the development of metabolic derangements, including metabolic acidosis (serum bicarbonate < 22 mEq/L) and hyperkalemia (serum potassium > 5.1 mEq/L). Zero-balance ultrafiltration (Z-BUF) is the process by which a solution (replacement fluid) is infused into the CPB circuit and an equal volume of fluid is removed via an ultrafiltration column. This process allows small molecules to be removed from the blood, while cells and most proteins remain. Z-BUF was initially conceptualized to reduce the inflammatory mediators associated with CPB

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