Faculty Opinions recommendation of The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery.

Each year more than 41,000 blood donations are needed every day and 30 million blood components are transfused. Blood products that can be transfused include Packed Red Cells (PRC), Whole Blood (WB), Thrombocyte Concentrate (TC), Fresh Frozen Plasma (FFP). Monitoring Hemoglobin (Hb) after transfusion is essential for assessing the success of a transfusion. The time factor after transfusion for Hemoglobin (Hb) examination needs to be established, analyze to judge the success of a blood transfusion which is performed. The aim of this study was to analyze the differences in changes of hemoglobin between 6-12 hours, and 12-24 hours after-transfusion. This study was retrospective observational using secondary data. The subjects were patients who received PRC, and WBC transfusion. At 6-12, and 12-24 hours after-transfusion, hemoglobin, RBC, and hematocrit were measured. Then the data were analyzed by unpaired t-test. The collected data included the results of the Hb pre-transfusion, 6-12, and 12-24 hours after-transfusion. The subjects of this study were 98 people. The administration of transfusion increased by 10-30% in hemoglobin concentration at 6-12 hours after-transfusion. While at 12-24 hours after-transfusion, hemoglobin after-transfusion increased 15-37% from the baseline. Hemoglobin values were not different at any of the defined after-transfusion times (p = 0.76 (p>0.05)). Hemoglobin values were not different at 6-12 hours, and 12-24 hours after-transfusion. Keywords: Hemoglobin, measurement, after-transfusion

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METHOD OF ERYTHROCYTE PROTECTION IN URGENT CARDIAC SURGERY

Emergency Medical Service ◽

10.36740/iemems202102103 ◽

2021 ◽

Vol 8 (2) ◽

pp. 68-74

Author(s):

Volodymyr І. Cherniy ◽

Lada O. Sobanska

Keyword(s):

Cardiac Surgery ◽

Blood Cells ◽

Blood Count ◽

Negative Impact ◽

Hemoglobin Concentration ◽

Negative Influence ◽

Control Group ◽

Extracorporeal Circuit ◽

Free Hemoglobin ◽

Erythrocyte Membrane Permeability

Aim: The use of a simple, safe and convenient method of treatment extracorporeal circuit with «adaptation composition » (AdC) for the reduction of negative impact on the state of erythrocytes and tissue hypoxia. Material and methods: The research included 150 patients. They were divided into two groups. The first group included patients who underwent surgery with the treatment of an extracorporeal circuit by AdC, the second group was the control group. Сomplete blood count parameters, plasma free hemoglobin concentration, erythrocyte mechanical and osmotic resistance, erythrocyte membrane permeability and acid hemolysis were studied. Results: Use of AdC prevents adsorption the blood cells on the surface of the extracorporeal circuit and protects the erythrocytes during cardiopulmonary bypass in urgent cardiac surgery. Conclusions: The treatment of oxygenator with AdC reduces the negative influence СРВ on state of RBC. Membranes of erythrocytes were more resistant to traumatic factors in the group with AdC.

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Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Journal of International Medical Research ◽

10.1177/0300060517741064 ◽

2017 ◽

Vol 46 (3) ◽

pp. 1130-1137 ◽

Cited By ~ 3

Author(s):

Canan Balci ◽

Engin Haftaci ◽

Atike Tekeli Kunt

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Oxygen Saturation ◽

Near Infrared ◽

Artery Bypass ◽

Kidney Injury ◽

Hemoglobin Concentration ◽

Cerebral Oximetry ◽

Cerebral Oxygen Saturation ◽

Cerebral Oxygen

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO2) measured intraoperatively and postoperatively in patients undergoing cardiac surgery. Methods We retrospectively analyzed the prospectively collected data of 45 adult patients with normal renal function who underwent isolated coronary artery bypass grafting (CABG) from January 2014 to May 2014. Kidney injury was assessed according to the Acute Kidney Injury Network criteria. rScO2 and hemoglobin were measured every hour intraoperatively and for the first 24 hours postoperatively. Results The hemoglobin concentration and rScO2 were significantly lower in patients with than without AKI, and no linear trends were observed. No exact cut-off values were obtained. Conclusion This retrospective study shows that a lower rScO2 and hemoglobin concentration are correlated with AKI after CABG in patients with no peripheral vascular disease or recent myocardial infarction. We suggest that cerebral oximetry alone may predict postoperative AKI well.

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TISSUE OXYGENATION IN PATIENTS WITH LOW HEMOGLOBIN CONCENTRATION DURING CARDIAC SURGERY; COMPARISON OF TWO METHODS

Anesthesia & Analgesia ◽

10.1097/00000539-199802001-00052 ◽

1998 ◽

Vol 86 (Supplement) ◽

pp. 52S

Author(s):

Y Ates ◽

N Canakci ◽

J Hallioglu ◽

B Aygunes ◽

A Aslan ◽

...

Keyword(s):

Cardiac Surgery ◽

Tissue Oxygenation ◽

Hemoglobin Concentration

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Transfusion Requirements In Cariovascular Surgery (TRICI).

Blood ◽

10.1182/blood.v116.21.1114.1114 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1114-1114 ◽

Cited By ~ 1

Author(s):

Nadine Shehata ◽

Laura Alexandra Burns ◽

Howard Nathan ◽

Paul Hebert ◽

Gregory T Hare ◽

...

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Sample Size ◽

Hemoglobin Concentration ◽

Transfusion Strategy ◽

High Risk Patients ◽

Randomized Controlled ◽

Liberal Group ◽

Risk Patients

Abstract Abstract 1114 Background: Determination of the optimal hemoglobin concentration (Hb) for red cell (RBCs) transfusion is essential for patients undergoing cardiac surgery as mortality may be dependent on the severity of anemia and administration of RBCs. As there is considerable variability in transfusion practices, a pilot feasibility study is required to ensure that adherence to proposed strategies can be achieved before conducting a definitive study requiring thousands of patients. The primary objective of this study was to assess overall adherence to two transfusion strategies. Methods: We conducted a single centre parallel randomized controlled pilot trial to assess adherence to two transfusion strategies. The randomization sequence was created using block randomization by age and Cardiac Anesthesia Risk Score in groups of 4. High risk patients were allocated to a “restrictive” transfusion strategy (RBCs if their Hb was 70 g/L or less intraoperatively during cardiopulmonary bypass (CPB) and 75 g/L or less postoperatively following CPB); or a “liberal” transfusion strategy (RBCs if their Hb was 95 g/L or less during CPB and less than 100 g/L postoperatively). We defined adherence as adherence to the transfusion strategies for each patient for more than 90% of their days in hospital. We also assessed reasons for non-adherence and clinical outcomes. A total sample size of 50 patients was estimated to produce a 97% confidence interval equal to the sample adherence prevalence plus or minus 8% when the true prevalence of adherence was hypothesized to be 90%. We estimated our sample size using PASS 2002 software. The significance level was set at p<0.05 for all statistical analyses. Results: Fifty patients were randomized, 25 in the liberal group and 25 in the restrictive group. Overall, 99 units of RBCs were transfused in the liberal group compared 50 units in the restrictive group (p<0.01). Forty eight units of RBCs were administered intraoperatively for the liberal group compared to 14 RBC units for the restrictive group (p< 0.01). Ninety eight units were transfused in the liberal group according to the transfusion strategy compared to 42 units in the restrictive group (p=0.01). The median number of days of adherence to the transfusion strategy was 8 (interquartile range 12) in the restrictive arm and 6 days (interquartile range 3) in the liberal arm (Table, p<0.05). The proportion of patients with 100% adherence was higher in the liberal group i.e., more patients in the restrictive group received transfusions without meeting a transfusion criterion. This was also reflected in the proportion of red cells administered according to the transfusion strategy. The percent of adhered transfusion thresholds was 70% in the restrictive arm and 65% in the liberal arm. The adherence rate was highest in the operating room followed by the cardiovascular intensive care unit then the ward (Table). Reasons for non adherence included attending staff opinion that transfusion not indicated, patient refusal, the use of hemoconcentration to increase the hemoglobin concentration, hemorrhage, use of hematocrit instead Hb to transfuse the patient, confusion whether the transfusion strategy was to be applied on the ward, hyperkalemia, repetition of the complete blood count before transfusing the patient, and the staff was too busy. Conclusions: This is the first randomized controlled trial that has assessed adherence rates to transfusion strategies in high-risk patients undergoing cardiac surgery. Determination of adherence rates to transfusion strategies is essential as adherence rates can impact outcomes if a considerable proportion of enrolled patients do not receive a transfusion according to their transfusion strategy. Poor adherence may impact outcomes despite the subsequent use of intention to treat analysis. Restrictive strategies can reduce transfusion, but further studies will be required to determine whether restrictive transfusions confer risk. Disclosures: Shehata: Canadian Blood Services: Employment, Research Funding.

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The effect of SANGUINATE® (PEGylated carboxyhemoglobin bovine) on cardiopulmonary bypass functionality using a bovine whole blood model of normovolemic hemodilution

Perfusion ◽

10.1177/0267659119850681 ◽

2019 ◽

Vol 35 (1) ◽

pp. 19-25

Author(s):

Bryan T Romito ◽

Mandy M McBroom ◽

Dawn Bryant ◽

Jacob Gamez ◽

Akeel Merchant ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

High Risk ◽

Blood Transfusion ◽

Whole Blood ◽

Oxygen Carrier ◽

Hemoglobin Concentration ◽

Arterial Line ◽

Pump Speed ◽

Normovolemic Hemodilution

Background: Cardiac surgery using cardiopulmonary bypass carries a high risk of bleeding and need for blood transfusion. Blood administration is associated with increased rates of morbidity and mortality. Perioperatively, strategies are often employed to reduce blood transfusions in high-risk patients or in situations where blood transfusion is contraindicated. Normovolemic hemodilution is a blood conservation technique used during cardiac surgery that involves replacement of blood with fluids. SANGUINATE® (PEGylated carboxyhemoglobin bovine) is a novel hemoglobin-based oxygen carrier that can deliver oxygen effectively to tissues in the presence of severe hypoxia. The use of a hemoglobin-based oxygen carrier during hemodilution may augment tissue oxygen delivery and reduce blood transfusion. Methods: Six standardized cardiopulmonary bypass runs simulating normovolemic hemodilution using varying proportions of bovine whole blood and SANGUINATE were performed. Pump speed, flow rate, line pressures, hemoglobin concentration, oxygenation, and degree of anticoagulation were assessed at regular intervals. Membrane oxygenators and arterial line filters were inspected for evidence of clotting following each run. Results: Increases in the pressure drop across the membrane oxygenator were detected during runs 5 and 6. Median activated clotting time values were able to be maintained at goal during the runs, and SANGUINATE did not appear to be thrombogenic. Hemoglobin concentration decreased following the addition of SANGUINATE. Oxygenation was maintained during all runs that included SANGUINATE. Conclusion: SANGUINATE does not impact the performance of the cardiopulmonary bypass circuit in a bovine whole blood model. The results support further evaluation of SANGUINATE in the setting of normovolemic hemodilution and cardiopulmonary bypass.

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Effective method of monitoring cerebral tissue oxygen saturation in cardiac surgery patients by combined use of tNIRS-1 and bispectral index

Scientific Reports ◽

10.1038/s41598-021-03527-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

A. Sugiura ◽

K. Torii ◽

H. Tsutsumi ◽

T. Someya ◽

D. Yasuoka ◽

...

Keyword(s):

Cardiac Surgery ◽

Oxygen Saturation ◽

Bispectral Index ◽

Hemoglobin Concentration ◽

Tissue Oxygen Saturation ◽

Cerebral Hypoxia ◽

Tissue Oxygen ◽

Cerebral Tissue ◽

Combined Use ◽

The Relationship

AbstractTo continuously and noninvasively monitor the cerebral tissue oxygen saturation (StO2) and hemoglobin concentration (gasHb) in cardiac surgery patients, a method combining the use of a cerebral tissue oximeter using near infrared time-resolved spectroscopy (tNIRS-1) and the bispectral index (BIS) was developed in this study. Moreover, the correlation between the estimated hemoglobin concentration (estHb), measured via tNIRS-1, and the hemoglobin concentration (gasHb), analyzed using a blood gas analyzer, were compared. The relationship between the BIS and gasHb was also examined. Through the comparison of BIS and StO2 (r1), and estHb and gasHb (r2), the correlation between the two was clarified with maximum r1 and r2 values of 0.617 and 0.946, respectively. The relationship between BIS and gasHb (r3), showed that there was a favorable correlation with a maximum r3 value of 0.969. There was also a continuous correlation between BIS and StO2 in patients undergoing cardiac surgery. In addition, a strong correlation was found between estHb and gasHb, and between BIS and gasHb. It was therefore concluded that the combined use of BIS and tNIRS-1 is useful to evaluate cerebral hypoxia, allowing for quick response to cerebral hypoxia and reduction of hemoglobin concentration during the operation.

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