Cardiopulmonary Bypass Priming Fluid Research Articles

Is it useful to wash stored red blood cells in cardiopulmonary bypass priming fluid for neonatal cardiac surgery? A single-centre retrospective study.

Neonatal cardiac surgery requires careful consideration of cardiopulmonary bypass (CPB) priming fluid composition due to small blood volume and immature physiology. This study investigated the impact of allogeneic stored red blood cells (RBCs) processed using an autotransfusion system in CPB priming fluid for neonates. We compared perioperative parameters, inflammatory mediators, coagulation indicators, vasoactive-inotropic score (VIS) and clinical outcomes between neonates receiving unwashed (n = 56) and washed (n = 45) RBCs in CPB priming fluid. Regression models were used to assess the independent association between RBC washing and patient outcomes. The autotransfusion system improved stored RBC quality. The washed group showed higher peak haematocrit (p < 0.01) and haemoglobin levels (p = 0.04) during CPB, an increased oxygen delivery index during rewarming (p < 0.05) and lower postoperative lactate levels and VIS (p < 0.05). Inflammatory (IL-6, IL-8 and IL-10) and coagulation parameters (D-dimer, fibrinogen and fibrin degradation product) fluctuated compared with baseline but did not significantly differ between groups. The washed group had a lower incidence of hyperlactacidaemia and delayed sternal closure at CPB weaning. Adding washed allogeneic stored RBCs to neonatal CPB priming fluid reduced postoperative lactate elevation and VIS without early improvement in the inflammatory and coagulation systems.

Comparison of Albumin, Hydroxyethyl Starch and Ringer Lactate Solution as Priming Fluid for Cardiopulmonary Bypass in Paediatric Cardiac Surgery.

In paediatric cardiac surgery, there is still not any information with regard to the best choice of priming fluids for Cardiopulmonary Bypass (CPB). Albumin, Hydroxyethyl Starch (HES) & ringer lactate are equally used, but each has its advantages & disadvantages. Albumin & HES had better fluid balance which affect outcome in paediatric cardiac surgery significantly. To compare priming solution containing albumin, hydroxyethyl starch and ringer lactate during elective open-heart surgery in paediatrics aged up to 3 years. All patients were managed by standardized institution protocol and were randomly distributed into three groups based on the priming solution which is used in the CPB Circuit and having 35 patients in each group. Group A: Receive albumin 10 ml/kg in priming solution, Group B: Receive Hydroxyethyl starch (HES130/0.4) 6% 20ml/kg in priming solution, Group C: Receive ringer lactate priming solution. Primary outcome variable included perioperative haemoglobin, total protein, colloid osmotic pressure, platelets, fluid balance, urine output, post-operative blood loss, blood products usage, renal & liver function, extubation time, ICU stay & outcome. Patients receiving albumin had higher perioperative platelet count, total protein level & colloid osmotic pressure, lesser post-operative blood loss & blood products requirement. Patients receiving HES had lower level of platelets postoperatively than ringer lactate group but not associated with increase blood loss. HES did not affect renal function & haemostasis in this dose. Patients receiving ringer lactate had positive fluid balance intraoperatively. All three groups have similar effect on renal & liver function, urine output, time to extubation, ICU stay & outcome. We conclude that albumin is expensive but better prime as maintain haemostasis, colloid oncotic pressure & reduced blood product requirement. HES will not hamper haemostasis & renal function in lower dose & better than crystalloid as maintain negative fluid balance. Patient outcome & ICU stay was similarly affected by priming solutions.

Positive cultures from cardiopulmonary bypass: prevalence and relevance regarding postoperative infection

Postoperative infections due to cardiopulmonary bypass (CPB) are associated with high morbidity and mortality. The value of positive cultures taken from CPB priming fluid and CPB blood samples, however, is unclear. This study investigates the epidemiology of positive cultures from CPB and their relation to the occurrence of postoperative infection. The study was conducted at the Maastricht University Medical Centre, a 715-bed teaching hospital with 900-1000 surgeries requiring CPB annually. From 1 January 1998 until 31 March 2010, all patients with positive CPB cultures drawn either from priming fluid or blood were retrospectively studied. Second, 335 patients with a positive CPB culture were compared with 335 randomly assigned patients who underwent cardiovascular surgery using CPB and had negative CPB cultures. Patients with active endocarditis were excluded. Demographic data and perioperative parameters were documented. Outcome measures were: a relevant infection (acute infectious valve endocarditis, wound infection, intravascular catheter-related infection, and bloodstream infection), occurrence of fever of unknown origin, and 30-day mortality. A total of 21840 cultures were analyzed, half being priming fluid and half CPB blood cultures. As many as 111 out of 10920 (1.0%) priming fluid cultures and 598 out of 10920 (5.6%) blood cultures tested positive. Gram-positive cocci predominated both priming fluid and blood cultures. Relevant postoperative infections within 30 days after surgery were seen in 47/663 (7.1%) of patients overall, in 27/330 in the CPB-culture-positive group (8.2%) and 20/333 in the CPB-culture-negative group (6.0%), p=0.275. As many as 38 out of 363 patients (5.7%) were affected by fever of unknown origin (CPB-culture-positive group 4.5%, and CPB-culture-negative 6.9%; p=0.191). The 30-day mortality was 16/330 (4.8%) in the CPB-culture-positive group and 13/333 (3.9%) in the CPB-culture-negative group (p=0.552). Positive cultures from both CPB priming fluid and CPB blood samples were not a rarity and mainly involved skin bacteria, arguing that contamination may have played a role. The risk of postoperative infection within 30 days after surgery was not increased in CPB-culture-positive patients. Therefore, no evidence was found to support routine culturing of CPB samples in patients undergoing cardiothoracic surgery.

The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction*

The usefulness of mannitol in the priming fluid for cardiopulmonary bypass is uncertain in patients with normal renal function, and has not been studied in patients with established renal dysfunction. We studied 50 patients with serum creatinine between 130 and 250 micromol.l(-1) having cardiac surgery. Patients were randomised to receive mannitol 0.5 g.kg(-1), or an equivalent volume of Hartmann's solution, in the bypass prime. There were no differences between the groups in plasma creatinine or change in creatinine from baseline, urine output, or fluid balance over the first three postoperative days. We conclude that mannitol has no effect on routine measures of renal function during cardiac surgery in patients with established renal dysfunction.

Cardioprotection of Shenfu Injection (参附注射液) against myocardial ischemia/reperfusion injury in open heart surgery

To investigate the protective effect of Shenfu Injection (SFI) against myocardium ischemia/reperfusion injury (IRI) in mitral valve replacement (MVR) with cardiopulmonary bypass (CPB). Forty patients undergoing selective MVR were randomly assigned to the control group and trial Groups I, II, III, and IV according to the different administrations of SFI, 8 patients in each group. The changes of systolic blood pressure (SBP), mean blood pressure (MBP), diastolic blood pressure (DBP) in each group were monitored, respectively. The recovering percentage of spontaneous heart beat, the heart rate (HR) and cardiac rhythm as well as the abnormal duration of ECG-ST segment were recorded after the restoration of heart beat. The serum concentration of cardiac troponin I (cTnI), malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) were determined as well. (1) The SBP, MBP and DBP values, the recovering rate of spontaneous heart beat, HR, ECG-ST, atrioventricular block and ventricular arrhythmia were significantly improved in group IV compared with any other groups. (2) Compared with the control group, the postoperative serum contents of cTnI and MDA were significantly decreased, but the activity of SOD was significantly increased in group IV. SFI had a certain protective effect against myocardium IRI. Moreover, better efficacy was seen with the administration of 1.5 mL/kg SFI into CPB priming fluid and pumping 1.5 mL/kg SFI via CPB as soon as the clamped aorta was unclamped.

ヘパリン起因性血小板減少症を合併した症例に対する体外循環について

Microemboli may impair cognitive function in patients undergoing heart surgery. Prebypass filtration has been shown to reduce particle load in the cardiopulmonary bypass (CPB) priming fluid. This study was performed to detect the embolic load of CPB priming fluid, to determine the efficacy of a 0.2 microm prebypass filter (PBF) in reducing emboli in the range of 0.1-5 microm and to provide guidelines for the handling of the device. A total of 12 CPB circuits were tested in two groups, using a laser light scattering particle counter, sensitive to microemboli in the range of 0.1-5 microm. In control group A, priming fluid before administration to the CPB circuit was analyzed. Group B circuits contained microporous membrane oxygenators (N = 5); group C consisted of CPB circuits with excluded membrane oxygenators (N = 7). When group A was compared to groups B and C, significantly more microemboli were found in the categories 0.2 microm, 0.5 microm, 0.8 microm for both groups B and C (p < .05). Group C circuits had higher microemboli counts in the categories 1.5 microm and 3 microm (p < .05) when compared to group B. Microemboli bigger than 0.2 microm could be eliminated after 2 min of prebypass filtration with a CPB flow of 5 L/min. The number of microemboli smaller than 0.2 microm was reduced substantially. Small microemboli with a size of 0.1 microm originate mainly from the priming solution. Microemboli in the range of 0.2 microm, 0.5 microm, and 0.8 microm originate mainly from the CBP circuit. In circuits with bypassed membrane oxygenators, a higher microemboli count in the range of 1.5 microm and 3 microm may be explained by a possible filtering capacity of membrane oxygenators. The 0.2 microm PBF is an effective tool to reduce the particle load in the CPB priming fluid.

Reduction of Microemboli Count in the Priming Fluid of Cardiopulmonary Bypass Circuits

Microemboli may impair cognitive function in patients undergoing heart surgery. Prebypass filtration has been shown to reduce particle load in the cardiopulmonary bypass (CPB) priming fluid. This study was performed to detect the embolic load of CPB priming fluid, to determine the efficacy of a 0.2 μm prebypass filter (PBF) in reducing emboli in the range of 0.1–5 μm and to provide guidelines for the handling of the device. A total of 12 CPB circuits were tested in two groups, using a laser light scattering particle counter, sensitive to microemboli in the range of 0.1–5 μm. In control group A, priming fluid before administration to the CPB circuit was analyzed. Group B circuits contained microporous membrane oxygenators (N = 5); group C consisted of CPB circuits with excluded membrane oxygenators (N = 7). When group A was compared to groups B and C, significantly more microemboli were found in the categories 0.2 μm, 0.5 mμ, 0.8 μm for both groups B and C (p &lt; .05). Group C circuits had higher microemboli counts in the categories 1.5 μm and 3 μm (p &lt; .05) when compared to group B. Microemboli bigger than 0.2 μm could be eliminated after 2 min of prebypass filtration with a CPB flow of 5 L/min. The number of microemboli smaller than 0.2 μm was reduced substantially. Small microemboli with a size of 0.1 μm originate mainly from the priming solution. Microemboli in the range of 0.2 μm, 0.5 μm, and 0.8 μm originate mainly from the CBP circuit. In circuits with bypassed membrane oxygenators, a higher microemboli count in the range of 1.5 μm and 3 μm may be explained by a possible filtering capacity of membrane oxygenators. The 0.2 μm PBF is an effective tool to reduce the particle load in the CPB priming fluid.

The Systemic Inflammatory Response to Cardiopulmonary Bypass

The Systemic Inflammatory Response to Cardiopulmonary Bypass

A Comparison between 20% Albumin and 10% Pentastarch in Priming fluid for Cardiopulmonary bypass

A Comparison between 20% Albumin and 10% Pentastarch in Priming fluid for Cardiopulmonary bypass

Prospective randomized study of albumin and dextran 40 as priming fluid for cardiopulmonary bypass

Prospective randomized study of albumin and dextran 40 as priming fluid for cardiopulmonary bypass

開心術における赤血球濃厚液単独使用の有用性に関する検討 新鮮血使用例との比較

We have tried to save the blood in open-heart surgery, then concentrated the diluted blood remained in the reservoir after cardiopulmonary bypass (CPB), and transfused it to the patients through venous line. Also we have primed extracorporeal circuit with concentrated red blood cells. In this study, we compare the results of this method with it produced through transfusion and the priming of fresh whole blood and fresh frozen plasma, and investigate the effectiveness and safety in the usage of concentrated red blood cells as the priming fluid. (Material and Method) From January, 1984 to December, 1987, 84 adult patients underwent coronary artery bypass surgery. We classified them into two groups, depending on their priming fluid for extracorporeal circuit, fresh whole blood or concentrated red blood cells. In group I consisted of 41 patients, fresh whole blood was used for the priming and in group II, consisted of 43 patients, in which concentrated red blood cells were applied and the blood components remained in the reservoir after weaning from CPB were concentrated and returned to patients. In these two groups, we compare the hemodynamic functions and the hematorogical data and also evaluate the safety through the usage of concentrated red blood cells in open-heart surgery. (Results) The components and average amount of blood used in group I were 11.6±5.5 units of fresh whole blood and 8.2±5.9 units of fresh frozen plasma. In group II, they were 6.1±3.0 units of concentrated red blood cells and almost no fresh whole blood or fresh frozen plasma were required. The diluted volume of 1, 315±320ml in the CPB reservoir was concentrated to 620±275ml of blood components and transfused. The values of hemoglobin and hematocrit were significantly higher in group I than these in group II, but there were no significant differences in cardiac index, pulmonary capillary wedge pressure and stroke work index among hemodynamic functions. The incidence of post-transfusion hepatitis was 3/41(7.3%) in group I, while zero in group II. (Conclusion) Concentrated red blood cells could be applied safely as the priming fluid for CPB in open-heart-surgery, and are clearly effective in prevention of post-transfusion hepatitis. These results indicate that this method has a big advantage.

A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer’s solution as priming fluid for cardiopulmonary bypass

The ideal priming fluid for cardiopulmonary bypass is not known. We designed a study to determine whether there are important differences in the clinical effects of hydroxyethyl starch versus albumin when used in priming fluid, and in the clinical effects of colloid versus crystalloid priming fluid. We prospectively randomized 83 adult patients undergoing coronary artery bypass or valve replacement. All patients were managed by standardized protocol, and they received one of three priming fluids for bypass: hydroxyethyl starch (HES), 26 patients; albumin (ALB), 28 patients, and lactated Ringer's solution (LRS), 29 patients. The groups were stratified by body weight and type of operation. We measured 41 variables relating to operative time factors, fluid balance, bleeding, and organ function (renal, cardiac, and pulmonary) at several time intervals. The LRS group had a significantly lower colloid osmotic pressure than the other two groups, and the HES group had a substantially higher blood viscosity. Although the prothrombin time was significantly lower in the LRS group (p less than 0.05), the differences were very small and not clinically important. The platelet count in the HES group was significantly lower than in the other two groups immediately after bypass, but it was not different by the time the patients left the operating room. There were no differences among the groups in chest tube drainage, blood bank usage, or fluid balance. Postoperatively, the pulmonary shunt fraction was significantly greater in the LRS group. Body weight increased more in the LRS than in the HES and ALB groups (p = 0.01). No adverse reaction to the prime solutions was noted. The differences between the HES and ALB groups--prothrombin time, platelet count, and blood viscosity--had no apparent clinical effects; thus, the two may be considered clinically equivalent. The greater somatic and pulmonary fluid accumulation in the LRS group suggests that colloid is preferable to crystalloid in priming fluid.

Hydroxyethyl starch in priming fluid for cardiopulmonary bypass

The physiochemical characteristics of hydroxyethyl starch make it suitable for use as a colloidal blood plasma substitute. In high doses, this drug may interfere with blood coagulation. Because of its effectiveness and low cost, we have used hydroxyethyl starch rather than albumin in the priming fluid for cardiopulmonary bypass: 500 ml of 6% hydroxyethyl starch and 2,000 ml of lactated Ringer's solution. To determine if excessive bleeding has been associated with the use of hydroxyethyl starch, we reviewed 760 cardiac operations. The patients were 49.9 +/- 0.5 years old (mean +/- SEM) and weighed 73 +/- 1 kg. Blood loss during the first postoperative day was 578 +/- 25 ml, and 4.0 +/- 0.2 units of bank blood were utilized in the perioperative period. We have used an improved method of administering heparin and protamine for the past 3 years. In the 461 patients operated upon since then, blood loss was 437 +/- 21 ml, 2.9 +/- 0.1 units of bank blood were used, and excessive postoperative bleeding necessitated re-exploration in nine patients (2.0%). These results compare favorably with other recently published series in which hydroxyethyl starch was not used in the pump prime. Thus the dose of hydroxyethyl starch in our priming fluid does not appear to be associated with excessive bleeding. In view of its safety and low cost, hydroxyethyl starch is a suitable colloidal blood plasma substitute for use during cardiopulmonary bypass.