Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis, complement activation, postoperative blood loss and transfusion volume

Perfusion ◽  
2003 ◽  
Vol 18 (2) ◽  
pp. 115-121 ◽  
Author(s):  
C R Daane ◽  
H D Golab ◽  
J HJ Meeder ◽  
M J Wijers ◽  
A JJC Bogers
Keyword(s):  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Complement Activation ◽  
Postoperative Blood Loss ◽  
Concentrate Suspension ◽  
Thrombin Time ◽  
Platelet Suspension ◽  
Coagulation Parameters ◽  
Transfusion Requirements ◽  
Significant Difference

The aim of this prospective randomized study was to compare the effects of the transfusion of unprocessed and cell saver-processed residual cardiopulmonary bypass (CPB) volume on haemostasis, complement activation, postoperative blood loss and transfusion requirements after elective cardiac surgery. Blood samples were taken at eight points in time, perioperatively. Haematological data, including haemoglobin, haematocrit and platelet counts as well as coagulation parameters, including activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and the fibrinolytic parameter D-dimers, were measured from each blood sample. For the assessment of complement activation, the total complement CH50 was analysed. In addition, postoperative blood loss and transfusion requirements were measured during the first 24 hours, postoperatively. The results of the study showed impaired haemostasis after the transfusion of both unprocessed and processed CPB volume. No significant differences were found between the groups in the measured coagulation parameters. Nor was a significant difference found in the complement concentration. However, in patients trans-fused with unprocessed CPB volume, a significantly (p = 0.019) higher amount of blood loss was found, postoperatively. In the same group of patients, the number of units of allogeneic erythrocyte concentrate suspension transfused was also significantly (p = 0.023) higher during the first 24 hours, postoperatively, compared to the patients transfused with processed CPB blood. The number of units of fresh frozen plasma and platelet suspension transfused was not significantly different between the groups. In conclusion, processing CPB volume in combination with processing peroperative blood loss may result in reducing the volume of transfusion needed of allogeneic blood products.

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 350-362 ◽  
Author(s):  
Idris Ghijselings ◽  
Dirk Himpe ◽  
Steffen Rex
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Postoperative Blood Loss ◽  
Transfusion Requirements ◽  
Significant Difference ◽  
Secondary Outcomes

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

C1-esterase inhibitor following cardiopulmonary bypass: evaluation of coagulation parameters - a preliminary report

Perfusion ◽  
1992 ◽  
Vol 7 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Carlo Dellora ◽  
Paola Minola ◽  
Filippo Parodi
Keyword(s):  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Postoperative Blood Loss ◽  
Factor Xii ◽  
Double Blind ◽  
C1 Esterase Inhibitor ◽  
Heparin Administration ◽  
Transfusion Requirements ◽  
Esterase Inhibitor

This study was designed to evaluate the effects of C1-esterase inhibitor (C1-INH) on haemostasis and blood loss in routine cardiopulmonary bypass (CPB). To determine whether or not C1-INH reduces blood loss or transfusion requirements after routine CPB, we randomized 20 patients to receive double-blind either C1-INH (15 IU/kg over 10 minutes intravenously) or placebo following heparin administration. The two groups were similar in age, sex, prior salicylate use and time on CPB. At 30 minutes from the beginning of CPB and postprotamine, factor XII, factor XI, C1-INH and prekallikrein activity were significantly higher ( p < 0.05) than in the placebo group. No manifestations of hypercoagulability were seen in either group. Despite this haemostatic effect, patients treated with C1-INH had similar postoperative blood loss to the placebo group and similar blood transfusion requirements. We conclude that routine use of C1-INH in CPB is unwarranted.

The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

1995 ◽  
Vol 74 (04) ◽  
pp. 1064-1070 ◽  
Author(s):  
Marco Cattaneo ◽  
Alan S Harris ◽  
Ulf Strömberg ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Controlled Trials ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Transfusion Requirements ◽  
The Mean ◽  
Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

scholarly journals High-dose Aprotinin in Cardiac Surgery—A Prospective, Randomized Study

1994 ◽  
Vol 22 (5) ◽  
pp. 529-533 ◽  
Author(s):  
M. J. Swart ◽  
P. C. Gordon ◽  
P. B. Hayse-Gregson ◽  
R. A. Dyer ◽  
A. L. Swanepoel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Placebo Group ◽  
Blood Loss ◽  
Artery Bypass ◽  
Randomized Study ◽  
Postoperative Blood Loss ◽  
High Dose ◽  
Maintenance Infusion ◽  
Transfusion Requirements ◽  
High Dose Aprotinin

Fifty patients undergoing primary coronary artery bypass surgery and 50 patients undergoing valve surgery received either high-dose aprotinin (2 million units loading dose, 2 million units added to the CPB prime, and 500,000 units/hr maintenance infusion) or placebo. Mean postoperative blood loss in the first six hours was reduced from 321 ml in the placebo group to 172 ml in the aprotinin group (95% confidence interval (CI) for difference = 95 to 189 ml). Seven patients in the placebo group and 16 patients in the aprotinin group did not require transfusion with homologous blood. This study adds to the growing body of evidence that the administration of high-dose aprotinin reduces blood loss and blood transfusion requirements associated with primary cardiac surgery.

Ultrafiltration during Cardiopulmonary Bypass in Children Reduces Postoperative Blood Loss

1994 ◽  
Vol 81 (SUPPLEMENT) ◽  
pp. A1398
Author(s):  
D. Journois ◽  
L. Vaccaroni ◽  
W. J. Greeley
Keyword(s):  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Postoperative Blood Loss

Factors Associated with Excessive Postoperative Blood Loss and Hemostatic Transfusion Requirements

1997 ◽  
Vol 41 (1) ◽  
pp. 9
Author(s):  
G. J. DESPOTIS ◽  
K. S. FILOS ◽  
T. N. ZOYS ◽  
C. W. HOGUE ◽  
E. SPITZNAGEL ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postoperative Blood Loss ◽  
Factors Associated ◽  
Transfusion Requirements

Reducing Perioperative Blood Loss in Patients Undergoing Total Hip Arthroplasty

1998 ◽  
Vol 21 (1) ◽  
pp. 47-51
Author(s):  
A. D'Ambrosio ◽  
B. Borghi ◽  
A. Damato ◽  
G. D'Amato ◽  
D. Antonacci ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
General Anesthesia ◽  
General Anaesthesia ◽  
Hip Arthroplasty ◽  
Epidural Anaesthesia ◽  
Postoperative Blood Loss ◽  
Total Hip ◽  
Perioperative Blood Loss ◽  
Transfusion Requirements

In this prospective, randomised, double-blind study, we investigated the effect of epidural anaesthesia and an antifibrinolytic agent, Aprotinin (500,000 KIU in bolus before surgery and 500,000 KIU h-1 in drip form during surgery), on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty. Sixty patients were allocated randomly to four groups (A: epidural + general anesthesia + Aprotinin, B: epidural + general anesthesia + placebo (equal volume), C: general anaesthesia + Aprotinin, D: general anaesthesia + placebo). Postoperative analgesia: epidural analgesia in groups A and B, systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco, and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours. Perioperative blood loss, frequency and quantity of transfusions were significantly higher in group D (p < 0.0001). Total blood loss was reduced by 31.3% by epidural anaesthesia, 20.4% by Aprotinin and 51.4% using a combination of the two techiniques.

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