Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids

Malmqvist, Gunnar; Lingehall, Helena Claesson; Appelblad, Micael; Svenmarker, Staffan

doi:10.1177/0267659118793249

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…However, the osmolality increased significantly during CPB in all the patients, but only to a level slightly above the normal range, and it remained slightly elevated throughout surgery. This finding is in line with the previous study by Malmqvist et al The much less pronounced increase in osmolality in our study, compared to that reported by Malmqvist et al, may be due to differences in the prime solutions. In addition, the high potassium content of the cardioplegia solution and substitutional treatment with electrolytes per‐ and postoperatively in our study may have contributed to the increase in osmolality.…”

Section: Discussionsupporting

confidence: 94%

“…Changes in plasma osmolality during cardiac surgery have been poorly investigated. The use of hyperosmolar CPB prime has been reported to result in a dramatic elevation of the plasma osmolality, which may have negative effects on the central nervous system . No studies on the impact of mannitol on plasma osmolality following CPB could be found in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…We therefore designed a prospective, randomized, double‐blind study to investigate the effects of mannitol when it is used in the CPB prime solution. According to a recent report by Malmqvist et al measured plasma osmolality is a more exact way to determine electrolyte balance than calculated osmolality during CPB and it should be included in studies when the effect of CPB prime solutions evaluates . Plasma osmolality was therefore measured in our study with the freezing point depression method as it is an accurate technique for determining osmolality …”

Section: Introductionmentioning

confidence: 97%

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The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial

Ljunggren

Sköld

Dardashti

et al. 2019

Acta Anaesthesiol Scand

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BackgroundThe optimal prime solution for the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol is widely used in the priming solution for CPB despite the fact that there is no clear consensus on the role of mannitol in cardiac surgery. The aim of this study was to investigate the effect of mannitol in the CPB prime solution.MethodsThis prospective, randomized, double‐blind study included 40 patients with normal cardiac and renal functions, who underwent coronary artery bypass grafting. One group received a prime based on Ringer's acetate (n = 20), and the other a prime consisting of Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality, acid‐base status, electrolytes, and renal‐related parameters were monitored.ResultsNo significant differences were found in osmolality between the Ringer's acetate group and the mannitol group at any time. The mannitol group showed a pronounced decrease in sodium, from 138.7 ± 2.8 mmol/L at anaesthesia onset, to 133.9 ± 2.6 mmol/L after the start of CPB (P < .001). No differences were seen in the renal parameters between the groups, apart from a short‐term effect of mannitol on peroperative urine production (P = .003).ConclusionWe observed no effects on osmolality of a prime solution containing mannitol compared to Ringer's acetate‐based prime in patients with normal cardiac and renal function. The use of mannitol in the prime resulted in a short‐term, significant decrease in sodium level.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial

Ljunggren

Sköld

Dardashti

et al. 2019

Acta Anaesthesiol Scand

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“… Standard 13.1: The Perfusionist shall consider the impact the prime has on the smaller circulating blood volume of the pediatric patient and its effect on: electrolyte levels colloid osmotic pressure coagulation Standard 13.2: When priming with exogenous blood, a circuit prime gas and electrolyte levels shall be obtained prior to initiation of bypass and adjustments made to correct any physiologic abnormalities. 21,22 Guideline 13.1 : When priming with exogenous blood, the use of prebypass ultrafiltration (preBUF) or washed red blood cells should be used during priming procedure. 23 -28 Guideline 13.2 : The perfusionist should consider matching prime composition to the individual patient values. …”

Section: Resultsmentioning

confidence: 99%

“…Standard 13.2: When priming with exogenous blood, a circuit prime gas and electrolyte levels shall be obtained prior to initiation of bypass and adjustments made to correct any physiologic abnormalities. 21,22…”

Section: Resultsmentioning

confidence: 99%

American Society of ExtraCorporeal Technology: Development of Standards and Guidelines for Pediatric and Congenital Perfusion Practice (2019)

Oldeen

Angona

Hodge

et al. 2020

World J Pediatr Congenit Heart Surg

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The development of standards and guidelines by professional societies offers clinicians guidance toward providing evidence-based care. The ultimate goals of standards and guidelines are to standardize care and improve patient safety and outcomes while also minimizing risk. The American Society of ExtraCorporeal Technology (AmSECT) currently offers perfusionists several clinical resources, primarily the Standards and Guidelines for Perfusion Practice; however, no document exists specific to pediatric perfusion. Historically, the development of a pediatric-specific document has been limited by available scientific evidence due to smaller patient populations, sample sizes, and variable techniques among congenital perfusionists. In the current setting of evolving clinical practices and increasingly complex cardiac operations, a subcommittee of pediatric perfusionists developed the Standards and Guidelines for Pediatric and Congenital Perfusion Practice. The development process included a comprehensive literature review for supporting evidence to justify new recommendations or updates to the existing AmSECT Adult Standards and Guidelines document. Multiple revisions incorporating feedback from the community led to a finalized document accepted by the AmSECT membership and made available electronically in May 2019. The Standards and Guidelines for Pediatric and Congenital Perfusion Practice is an essential tool for pediatric perfusionists and serves as the backbone for institutionally based protocols, promotes improved decision-making, and identifies opportunities for future research and collaboration with other disciplines. The purpose of this manuscript is to summarize the process of development, the content, and recommended utilization of AmSECT’s Standards and Guidelines for Pediatric and Congenital Perfusion Practice.

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American Society of ExtraCorporeal Technology: Development of Standards and Guidelines for Pediatric and Congenital Perfusion Practice (2019)

Oldeen,

Angona,

Hodge

et al. 2020

J Extra Corpor Technol

View full text Add to dashboard Cite

The development of standards and guidelines by professional societies offers clinicians guidance toward providing evidence-based care. The ultimate goals of standards and guidelines are to standardize care and improve patient safety and outcomes while also minimizing risk. The American Society of ExtraCorporeal Technology (AmSECT) currently offers perfusionists several clinical resources, primarily the Standards and Guidelines for Perfusion Practice; however, no document exists specific to pediatric perfusion. Historically, the development of a pediatric-specific document has been limited by available scientific evidence because of smaller patient populations, sample sizes, and variable techniques among congenital perfusionists. In the current setting of evolving clinical practices and increasingly complex cardiac operations, a subcommittee of pediatric perfusionists developed the Standards and Guidelines for Pediatric and Congenital Perfusion Practice. The development process included a comprehensive literature review for supporting evidence to justify new recommendations or updates to the existing AmSECT Adult Standards and Guidelines document. Multiple revisions incorporating feedback from the community led to a finalized document accepted by the AmSECT member and made available electronically in May 2019. The Standards and Guidelines for Pediatric and Congenital Perfusion Practice is an essential tool for pediatric perfusionists, serves as the backbone for institutionally based protocols, promotes improved decision-making, and identifies opportunities for future research and collaboration with other disciplines. The purpose of this article is to summarize the process of development, the content, and recommended utilization of AmSECT’s Standards and Guidelines for Pediatric and Congenital Perfusion Practice. AmSECT recommends adoption of the Standards and Guidelines for Pediatric and Congenital Perfusion Practice to reduce practice variation and enhance clinical safety.

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Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids

Cited by 10 publications

References 23 publications

The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial

The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial

American Society of ExtraCorporeal Technology: Development of Standards and Guidelines for Pediatric and Congenital Perfusion Practice (2019)

American Society of ExtraCorporeal Technology: Development of Standards and Guidelines for Pediatric and Congenital Perfusion Practice (2019)

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