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Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial
Author(s) -
Whitlock Richard,
Mathew Joseph,
Eikelboom John,
AlSaleh Ayman Mohammad,
Yuan Fei,
Teoh Kevin
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03958.x
Subject(s) - medicine , cardiopulmonary bypass , hematocrit , anesthesia , blood transfusion , blood product , cardiac surgery , hemostasis , intensive care unit , surgery , ultrafiltration (renal) , chemistry , chromatography
Background Processing residual cardiopulmonary bypass ( CPB ) volume via ultrafiltration may improve hemostasis and reduce transfusion through clearing activated complement, activated coagulation components, and proinflammatory cytokines. We sought to establish if processing residual CPB volume with ultrafiltration reduces homologous blood transfusion and bleeding. Study Design and Methods Adult patients undergoing isolated coronary artery bypass grafting ( CABG ) surgery were randomly assigned to receive processed (n = 99) or unprocessed (control; n = 98) residual CPB volume in this single‐center randomized controlled trial. The intensive care unit team, patients, and assessors were blinded to treatment assignment and a transfusion protocol was followed. Surgeons were permitted to use retrograde autologous priming to minimize crystalloid pump prime. Results The processed study bag was of a smaller volume (280 [0, 550] mL vs. 590 [215, 726] mL ; p < 0.01) but a higher hematocrit (29% [0%, 34%] vs. 23% [20%, 25%]; p < 0.01) than control. The rate of transfusion with homologous blood was 39% in both groups (p = 0.92). There was no difference in the volume transfused (processed 323 ± 585 mL vs. control 276 ± 520 mL ; p = 0.56). There was also no difference in the proportion of patients transfused with any blood product (processed 44% vs. control 45%; p = 0.95) or in the volume of chest tube output (processed 600 [500, 940] mL vs. control 670 [490, 932] mL ; p = 0.62). Conclusion Ultrafiltration of residual CPB volume in adults undergoing isolated CABG surgery does not reduce the need for transfusion or bleeding.