Effect of hemofiltrated whole blood pump priming on hemodynamics and respiratory function after the arterial switch operation in neonates

Nagashima, Mitsugi; Imai, Yasuharu; Seo, Kazuoh; Terada, Masatsugu; Aoki, Marcelo Saldanha; Shinoka, Toshiharu; Koide, Masaaki

doi:10.1016/s0003-4975(00)02024-5

Cited by 36 publications

(28 citation statements)

References 19 publications

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“…Because these values were not measured consistently at all sites and with a decreasing frequency during the study infusion, only limited conclusions can be drawn from these data. Consistent with previous studies, [2][3][4][5]15 the lowest mixed venous oxygen saturations and highest lactate values occurred in the first 12 hours after surgery. Although no statistically significant differences were identified between treatment groups, there was a trend toward a wider difference between arterial and mixed venous oxygen saturations at 8 and 12 hours after surgery in the placebo arm compared with those treated with high-dose milrinone (Figure 5, PϽ0.07).…”

Section: Secondary End Pointssupporting

confidence: 91%

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Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease

et al. 2003

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Background-Low cardiac output syndrome (LCOS), affecting up to 25% of neonates and young children after cardiac surgery, contributes to postoperative morbidity and mortality. This study evaluated the efficacy and safety of prophylactic milrinone in pediatric patients at high risk for developing LCOS. Methods and Results-The study was a double-blind, placebo-controlled trial with 3 parallel groups (low dose, 25-g/kg bolus over 60 minutes followed by a 0.25-g/kg per min infusion for 35 hours; high dose, 75-g/kg bolus followed by a 0.75-g/kg per min infusion for 35 hours; or placebo). The composite end point of death or the development of LCOS was evaluated at 36 hours and up to 30 days after randomization. Among 238 treated patients, 25.9%, 17.5%, and 11.7% in the placebo, low-dose milrinone, and high-dose milrinone groups, respectively, developed LCOS in the first 36 hours after surgery. High-dose milrinone significantly reduced the risk the development of LCOS compared with placebo, with a relative risk reduction of 55% (Pϭ0.023) in 238 treated patients and 64% (Pϭ0.007) in 227 patients without major protocol violations. There were 2 deaths, both after infusion of study drug. The use of high-dose milrinone reduced the risk of the LCOS through the final visit by 48% (Pϭ0.049). Conclusions-The use of high-dose milrinone after pediatric congenital heart surgery reduces the risk of LCOS.

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Section: Secondary End Pointssupporting

confidence: 91%

“…This fall in cardiac index was associated with an elevated systemic vascular resistance of Ϸ25% and a rise in pulmonary vascular resistance of nearly 40% from baseline values. Other recent reports document similar hemodynamic 3,4 and respiratory 5 findings after surgery in neonates and young infants.…”

supporting

confidence: 68%

Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease

et al. 2003

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“…These same authors suggest that this technique eliminated the initial drop in blood pressure commonly seen with initiation of CPB, reduced the incidence of postoperative edema, attenuated cardiac impairment, and reduced pulmonary dysfunction (23,24) .…”

Section: Pre-cpb Ultrafiltration Of Pump Primementioning

confidence: 99%

Ultrafiltration in Cardiac Surgery

Searles

Darling

2008

On Bypass

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“…Strategies to pre-treat this blood prime to reduce adverse reactions in neonatal cardiopulmonary bypass (CPB) have been proposed [2,3]. Journois et al [3] hemofiltered the blood prime prior to initiating CPB and then replaced the removed volume with a physiological electrolyte solution.…”

Section: Introductionmentioning

confidence: 99%

“…Journois et al [3] hemofiltered the blood prime prior to initiating CPB and then replaced the removed volume with a physiological electrolyte solution. Nagashima et al [2] also hemofiltered blood prior to CPB and replaced the removed volume with a maltose-, glucose-, and electrolyte-containing solution. In both cases, the authors reported some benefit to the technique.…”

Section: Introductionmentioning

confidence: 99%

Pre dialysis of blood prime in continuous hemodialysis normalizes pH and electrolytes

Pasko

Mottes

Mueller

2003

Pediatric Nephrology

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In critically ill children weighing <10 kg, it is necessary to use blood as a priming solution for the extracorporeal continuous renal replacement therapy (CRRT) circuit before initiating CRRT to prevent hemodilution and maintain adequate oxygenation. However, blood bank blood usually contains supra-physiological electrolyte concentrations and a non-physiological acid-base balance that may exacerbate the patient's condition. The objective of this trial was to develop a simple protocol to pre-treat blood bank-derived blood to yield a more physiological blood priming solution. Expired human blood in a recirculating in vitro CRRT circuit was dialyzed prior to the initiation of CRRT using a physiological dialysate solution. Serial blood samples were assessed for electrolyte and pH content. Regimens using maximal blood flow rates (180-200 ml/min) and aggressive dialysate flow rates (33-42 ml/min) were able to correct severely hyperkalemic and acidemic blood within 7.5 min. Initially elevated blood potassium concentrations >20 mEq/l were normalized to below 5 mEq/l within 7.5 min of dialysis in all cases. Blood bank-derived blood can be "conditioned" quickly to physiological pH and electrolyte concentrations using these simple pre-dialysis regimens. Unlike some blood preparation regimens that have been published, the technique used in this trial requires no special equipment or added medications that are not already used in CRRT.

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Effect of hemofiltrated whole blood pump priming on hemodynamics and respiratory function after the arterial switch operation in neonates

Cited by 36 publications

References 19 publications

Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease

Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease

Ultrafiltration in Cardiac Surgery

Pre dialysis of blood prime in continuous hemodialysis normalizes pH and electrolytes

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