Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed?

Habib, Robert H.; Zacharias, Anoar; Schwann, Thomas A.; Riordan, Christopher J.; Durham, Samuel J.; Shah, Aamir S.

doi:10.1016/s0022-5223(02)73291-1

Cited by 379 publications

(285 citation statements)

References 19 publications

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“…However, recent clinical and experimental studies have demonstrated that acute hemodilution can reduce tissue oxygen delivery to vital organs and increase organ injury and mortality. 2,[11][12][13][14] These data provide evidence that acute normovolemic hemodilution may be detrimental. The focus of the current review is on the risk associated with acute hemodilution (normovolemia) and not hemorrhage and hypotension (hypovolemia).…”

Section: The Risk Of Anemiamentioning

confidence: 72%

“…Despite these adaptations, increasing clinical evidence supports a strong association between anemia, increased organ injury, and mortality. [1][2][3][4][5][6][7][8][9][10] With the advent of modern medical intervention, the initial treatment of acute blood loss is fluid resuscitation with crystalloid and/or colloid. This treatment has led to an increased incidence of normovolemic hemodilution (hemodilution) in many clinical settings, including the operating room and intensive care unit.…”

Section: The Risk Of Anemiamentioning

confidence: 99%

“…Expanding clinical evidence suggests that acute hemodilution is associated with increased organ injury and mortality. 2,[15][16][17] Hemodilution increases the risk of stroke Acute stroke is a catastrophic complication associated with hemodilution during cardiopulmonary bypass (CPB). 2,12 Although exact mechanisms have not been defined, experimental studies suggest that tissue hypoxia contributes.…”

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

“…2,[15][16][17] Hemodilution increases the risk of stroke Acute stroke is a catastrophic complication associated with hemodilution during cardiopulmonary bypass (CPB). 2,12 Although exact mechanisms have not been defined, experimental studies suggest that tissue hypoxia contributes. 18 While a specific safe threshold hematocrit has not been established, prevention of a fall in the hematocrit to \ 25% may be beneficial in terms of reduced neurological injury and morbidity.…”

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

See 3 more Smart Citations

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Tsui

Dattani

Marsden

et al. 2010

Can J Anesth/J Can Anesth

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Section: The Risk Of Anemiamentioning

confidence: 72%

Section: The Risk Of Anemiamentioning

confidence: 99%

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

Section: The Risk Of Hemodilutional Anemiamentioning

confidence: 99%

See 2 more Smart Citations

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Tsui

Dattani

Marsden

et al. 2010

Can J Anesth/J Can Anesth

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“…[3][4][5][6] One of the most common causes of acute anemia is acute blood loss and fluid resuscitation (hemodilution). Therefore, we have adopted a model of acute hemodilutional anemia to study the cerebral gene responses.…”

Section: Introductionmentioning

confidence: 99%

L’expression génique dans le cortex cérébral de rats anémiques aigus: une analyse par microarray

Briet

Mazer

Tsui

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Hemodilution in perioperative patients has been associated with neurological morbidity and increased mortality by undefined mechanisms. This study assesses whether hemodilutional anemia up-regulated inflammatory cerebral gene expression (microarray) to help define the mechanism. Methods Hemodilution was performed in anesthetized rats by exchanging 50% of the estimated blood volume (30 mL kg -1 ) with pentastarch. Two groups of control animals were utilized, i.e., a non-anesthetized control (Normal Control) and an anesthetized control group (Anesthesia Control). Blood pressure, hemoglobin concentration, and arterial blood gas analysis were performed before and after hemodilution. Cerebral cortex was harvested from isoflurane-anesthetized rats (n = 6) after 6 and 24 hr of recovery and was used to perform complimentary DNA (cDNA) microarray analyses. Pro-inflammatory chemokine and cytokine protein levels were also measured.Results Microarray analysis demonstrated up-regulation of 72 and 27 genes (6 and 24 hr, respectively) in anemic cerebral cortex. These genes were involved in a number of biological functions, including (1) inflammatory responses; (2) angiogenesis; (3) vascular homeostasis; (4) cellular biology; and (5) apoptosis. Chemokine ribonucleic acid (RNA) expression (CXCL-1, -10, and -11) was highest in anemic brain tissue (P \ 0.0125 for each). Protein measurements demonstrated a significant increase in interleukin-6, tumor necrosis factor a, and monocyte chemoattractant protein-1 (P \ 0.05 for each). Conclusion This study utilizes microarray technology to elucidate changes in cerebral cortical gene expression in response to acute hemodilution. These findings demonstrate an increase in pro-inflammatory chemokines (RNA, protein) and cytokines (protein). An improved understanding of the inflammatory response to anemia may help to minimize associated morbidity and mortality. RésuméObjectif L'he´modilution en pe´riope´ratoire chez les patients a e´te´associe´e à une morbidite´neurologique et une mortalite´accrue en raison de me´canismes inde´termine´s. Cette e´tude examine si l'ane´mie par he´modilution re´gule al a hausse l'expression ge´nique ce´re´brale inflammatoire (microarray) afin d'aider a`de´finir ce me´canisme. Méthode Une he´modilution a e´te´re´alise´e chez des rats anesthe´sie´s en e´changeant 50 % du volume sanguin estime( 30 mLÁkg -1 ) avec du pentastarch. Deux groupes d'animaux te´moins ont e´te´utilise´s, soit un groupe te´moin non anesthe´sie´(te´moin normal) et un groupe te´moin anesthe´sie( te´moin anesthe´sie´). La pression arte´rielle, la concentration d'he´moglobine et une gazome´trie sanguine arte´rielle

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Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

et al. 2023

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ImportanceIt has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade.ObjectiveTo evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020.Design, Setting, and ParticipantsThis retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020.ExposureCoronary artery bypass.Main Outcomes and MeasuresThe primary outcome was operative mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay). The attributable risk (the association of female sex with coronary artery bypass grafting outcomes) for the primary and secondary outcomes was calculated.ResultsBetween 2011 and 2020, 1 297 204 patients underwent primary isolated coronary artery bypass grafting with a mean age of 66.0 years, 317 716 of which were women (24.5%). Women had a higher unadjusted operative mortality (2.8%; 95% CI, 2.8-2.9 vs 1.7%; 95% CI, 1.7-1.7; P &lt; .001) and overall unadjusted incidence of the composite of operative mortality and morbidity compared with men (22.9%; 95% CI, 22.7-23.0 vs 16.7%; 95% CI, 16.6-16.8; P &lt; .001). The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend = 0.38). The attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period (P for trend = 0.71).Conclusions and RelevanceWomen remain at significantly higher risk for adverse outcomes following coronary artery bypass grafting and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.

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Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed?

Cited by 379 publications

References 19 publications

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

L’expression génique dans le cortex cérébral de rats anémiques aigus: une analyse par microarray

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

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