A retrospective comparison of blood transfusion requirements during cardiopulmonary bypass with two different small adult oxygenators

Abstract

A low haematocrit during cardiopulmonary bypass (CPB) is associated with adverse outcomes and often results in homologous blood transfusions. Oxygenators with improved venous reservoir designs aid in reducing the priming volume. Recently, we changed our small adult oxygenator model from the D905 EOS oxygenator (Dideco, Mirandola, Italy) to the Capiox FX1540 (Terumo Corporation, Tokyo, Japan). We conducted a retrospective study of 42 patents to evaluate the impact of the Capiox FX 1540 on blood transfusion requirements in small patients (body surface area (BSA) up to 1.8 m(2)). The D905 EOS group had a lower minimum intraoperative haematocrit than the FX1540 group (20 ± 3 v 22 ± 4, p = 0.029) with 73% of the patients receiving intraoperative blood transfusions compared with 30% in the FX 1540 group (p = 0.012). Patients in the D905 EOS group received one blood transfusion more during CPB than the FX 1540 patients (p = 0.002). The haematocrits at the end of CPB and in the early postoperative period were identical in both groups. The postoperative ventilation time, length of stay in the intensive care unit and postoperative chest drain bleeding were similar in both groups. In conclusion, the Capiox FX1540 was effective in reducing intraoperative packed red cell transfusions.

Gender and intraoperative blood transfusion: analysis of 54,122 non-reoperative coronary revascularization procedures

“…36 Several studies have shown that reducing circuit size results in a smaller thumbprint for CPB without affecting the overall performance, with the reduction in hemodilution resulting in lower transfusion rates. 37,38 We recently examined the use of acute normovolemic hemodilution (ANH) in combination with autologous priming in cardiac surgical patients. 39 After controlling for multiple factors, it became evident that there was a gender-specific effect of both blood conservation measures.…”

Minimizing the perfusion system by integration of the components. Does it affect the hematocrit drop and transfused red blood cells? A retrospective audit

“…To reduce the amount of transfused RBCs in cardiac surgery there are many techniques and approaches, one of them is reducing the priming volume with an intended result of diminishing hemodilution. 1,2,11,13,14 This must affect the hematocrit values during CPB and reduce or obviate the need for transfusion of RBCs. Over a period of three years, we minimized our CPB circuit by the introduction of integrated components and optimizing the circuit with a better configuration.…”

“…To reduce the amount of transfused RBCs in cardiac surgery there are many techniques and approaches, one of them is reducing the priming volume with an intended result of diminishing hemodilution. 1,2,11,13,14 of three years, we minimized our CPB circuit by the introduction of integrated components and optimizing the circuit with a better configuration. The results of our first step in 2010 show a significant decrease in priming volume, from an average of 1630 ml down to a priming volume of 1380 ml, and, in 2011, we made a second step to reduce the priming volume to an average of 1250 ml.…”

“…In 2010, we changed to a system with an integrated arterial filter, with the goal of diminishing the priming volume. 13,14 In 2011, we again reduced our priming volume by optimizing the configuration of the disposables more according to our new heart-lung machines, Stöckert S5 (Sorin Group, Mirandola, Italy). The aim of this retrospective audit was to determine the affect on the hematocrit drop and the amount of transfused RBCs during CPB over the period 2008 until 2011 in three representative patient cohorts.…”

Patient-oriented blood-saving concept in operations with cardiopulmonary bypass

“…Не следует представленную методику рассматривать как концепцию полного отказа от трансфузии -основная идея заключалась в исключе-нии применения донорских эритроцитов у анемичных па-циентов на этапе перфузии, так как они потенцируют ге-молиз, разрушаясь на роликах насоса ИК, с последующей активизацией системного воспаления и проявлениями органной дисфункции. Показано, что оксигенаторы с низким объемом первичного заполнения и площадью по-верхности контура снижают потребность в переливании гомологичной крови и оптимизируют гемостаз [14,15]. Снижение гемодилюционной анемии и увеличение ми-нимальной концентрации Hb приводят, в том числе, и к меньшей потребности использования вазопрессоров в те-чение перфузии [8,16].…”