Original article: cardiovascular
Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery

https://doi.org/10.1016/S0003-4975(02)03513-0Get rights and content

Abstract

Background. Hemodilution occurring with cardiopulmonary bypass imposes a risk for blood transfusion. Autologous priming of the cardiopulmonary bypass circuit at the initiation of bypass partially replaces the priming solution with autologous blood. We examined the efficacy of autologous priming of the circuit in reducing blood transfusion.

Methods. One hundred and four patients were entered into a prospective, randomized, controlled study. Initiation of cardiopulmonary bypass was with or without autologous priming.

Results. With autologous priming, a mean volume of 808.8 ± 159.3 mL of priming solution was replaced with autologous blood. This allowed a higher hematocrit value on admission to the intensive care unit and at discharge from hospital. In all, 49% of the control group required a blood transfusion compared with 17% from the autologous priming group (p = 0.0007). The mean volume of blood transfused was 277.6 ± 363.8 mL in the control group compared with 70.1 ± 173.5 mL in the autologous priming group (p = 0.0005).

Conclusions. Retrograde autologous priming of the bypass circuit reduces homologous blood transfusion owing to the reduction in bypass circuit priming volume.

Section snippets

Patient population

A prospective, randomized, controlled study was performed in patients presented for primary coronary artery bypass grafting (CABG). The sample size was 100 based on demonstrating a reduction in transfusion from 60% (local audit data 1999) to 40%, with a confidence level of 0.95 and a power of 0.8. After local research ethics committee approval (study reference no. 99/151; December 15, 1999) and informed consent, 104 patients were prospectively randomly assigned to control (no prime

Baseline characteristics

The groups were closely matched for age, body weight, body surface area, NYHA classification, comorbid risk factors, and preoperative hematologic data (preoperative HCT = 43% in both groups). There were significantly more female patients in the RAP group (13 of 51, 25.49%) compared with the control group (4 of 49, 8.16%; p = 0.02).

Exclusions

Four patients from the control group were excluded from the study for the following reasons: in 1 patient deep hypothermic circulatory arrest was used because of a

Comment

Coronary artery bypass graft surgery is the most commonly performed cardiac operation and as many as 70% of patients require a blood transfusion despite improvements in cardiac surgical techniques. The transfusion rate varies between institution [9]. RAP of the CPB circuit is not a new technique. In 1960, Panico and Neptune [10] first described a method of autologously priming the CPB circuit to reduce the requirements for homologous blood, which was used to prime the CPB circuit at that time.

Acknowledgments

We thank Dr Manzoor Nazir from the Yorkshire Heart Centre, United Kingdom, for his help in analyzing electrocardiographic data.

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