High-volume ultrafiltration with extracellular fluid replacement for the management of dialysis patients during cardiopulmonary bypass

Lee, Laurence W.; Gabbott, Steven

doi:10.1053/jcan.2002.29684

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…Zero-balance ultrafiltration (ZBUF) is an alternative to the traditional intraoperative therapies and was first de- scribed in the pediatric population in the 1990s [31]. It is a form of convective ultrafiltration that utilizes pre-existing connections on the CPB circuit and a hemoconcentrator placed in parallel to in the circuit and has been shown to control intraoperative hyperkalemia [32]. The simplified CPB circuit is depicted in Figure 1, showing venous blood from the patient flowing into a cardiotomy reservoir before being pumped through an oxygenator and then returned to the patient.…”

Section: Intraoperative Managementmentioning

confidence: 99%

“…Different solutions have been described for this purpose, including crystalloids (0.9% normal saline, lactated Ringer's, Plasma-Lyte ® , Normosol ® ), CRRT dialysate solutions, and CRRT replacement fluids [20,32,33,[35][36][37][38]. Because high-volume normal saline is associated with hyperchloremic acidosis [33], most centers use a more balanced physiologic solution.…”

Section: Intraoperative Managementmentioning

confidence: 99%

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Optimizing Perioperative Renal Replacement Therapy for Patients Undergoing Cardiac Surgical Procedures Requiring Cardiopulmonary Bypass

et al. 2022

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Coronary artery disease is highly prevalent in patients with end-stage renal disease (ESRD), and cardiovascular complications remain the most common cause of death in this patient population. Accordingly, many cardiac surgical procedures requiring cardiopulmonary bypass support are performed on these patients each year, with morbidity and mortality rates far exceeding patients without ESRD. Anuric patients lack the normal renal homeostatic functions which typically allow for physiologic protection from challenges during the operation, such as volume overload, hyperkalemia, and acidemia. Careful preoperative planning and coordination to provide pre-, intra-, and postoperative renal replacement therapies for such patients are imperative. Many different strategies have been reported in the literature. Zero-balance ultrafiltration is a newer strategy which utilizes convective ultrafiltration much like pre-filter continuous renal replacement therapy and utilizes pre-existing connections on the cardiopulmonary bypass pump performed by the perfusion team. This allows for control of potassium concentration throughout the operation with existing personnel and minimal additional equipment. Here, we describe the unique challenges caring for patients receiving renal replacement therapy undergoing cardiac surgical procedures requiring cardiopulmonary bypass.

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Section: Intraoperative Managementmentioning

confidence: 99%

Section: Intraoperative Managementmentioning

confidence: 99%

Optimizing Perioperative Renal Replacement Therapy for Patients Undergoing Cardiac Surgical Procedures Requiring Cardiopulmonary Bypass

et al. 2022

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“…Z-BUF has effectively been used to remove inflammatory mediators and correct metabolic acidosis and hyperkalemia. 1,2,3 This case report describes the use of Z-BUF to correct metabolic alkalosis (MA).…”

Section: Introductionmentioning

confidence: 99%

Zero balance ultrafiltration to correct metabolic alkalosis occurring during veno-arterial extracorporeal membrane oxygenation

Blakey

Quader

2022

Perfusion

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Introduction We describe a case report of metabolic alkalosis that occurred during veno-arterial extracorporeal membrane oxygenation (VA ECMO) that was corrected during cardiopulmonary bypass (CPB) using zero balance ultrafiltration with normal saline (NS) 0.9%. Case Report A 67-year-old male received a heart transplant 6 days after being placed on VA ECMO. During VA ECMO the patient developed metabolic alkalosis. During CPB, zero balance ultrafiltration with NS 0.9% was used to correct metabolic alkalosis. Discussion Metabolic alkalosis during CPB is rare. To our knowledge, this is the first reported case of the use of zero balance ultrafiltration to effectively correct metabolic alkalosis. Conclusion Metabolic alkalosis during CPB may be corrected using zero balance ultrafiltration with NS 0.9%.

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“…bonate when the pH is low and/or dextrose-insulin when effects relatively independent of serum pH are desired), using zerobalanced ultrafiltration (Z-BUF) with normal saline as the replacement fluid (to remove potassium from the body rather than simply shift the electrolyte across cellular membranes), and, occasionally, hemodialysis (1). We report the application of Z-BUF using an electrolyte-balanced, low potassium dialysate solution rather than isotonic saline to avoid a high chloride load and the potential for hyperchloremic acidosis to successfully treat hyperkalemia while on cardiopulmonary bypass.…”

mentioning

confidence: 99%

“…2014;46:262-266 Although there are many types of cardioplegia solutions used to arrest the heart during cardiac surgery, almost all contain high levels of potassium. This hyperkalemic solution eventually mixes into the systemic circulation, raising extracellular potassium levels (1). Although potassium is predominantly an intracellular cation, a high extracellular concentration affects cardiac rhythm and hence myocardial contraction (2).…”

mentioning

confidence: 99%

Using Zero Balance Ultrafiltration with Dialysate as a Replacement Fluid for Hyperkalemia during Cardiopulmonary Bypass

Heath¹,

Raghunathan²,

Welsby³

et al. 2014

J Extra Corpor Technol

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Avoiding or managing hyperkalemia during cardiac surgery, especially in a patient with chronic renal insufficiency, can be challenging. Hyperkalemic cardioplegia solution is usually administered to achieve and maintain an electrical arrest of the heart. This solution eventually mixes in with the systemic circulation, contributing to elevated systemic potassium levels. Administration of packed red blood cells, hemolysis, tissue damage, and acidosis are also common causes of hyperkalemia. Current strategies to avoid or manage hyperkalemia include minimizing the volume of cardioplegia administered, shifting potassium from the extracellular into the intracellular space (by the administration of sodium bicarbonate when the pH is low and/or dextrose–insulin when effects relatively independent of serum pH are desired), using zero-balanced ultrafiltration (Z-BUF) with normal saline as the replacement fluid (to remove potassium from the body rather than simply shift the electrolyte across cellular membranes), and, occasionally, hemodialysis (1). We report the application of Z-BUF using an electrolyte-balanced, low potassium dialysate solution rather than isotonic saline to avoid a high chloride load and the potential for hyperchloremic acidosis to successfully treat hyperkalemia while on cardiopulmonary bypass.

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High-volume ultrafiltration with extracellular fluid replacement for the management of dialysis patients during cardiopulmonary bypass

Cited by 6 publications

References 5 publications

Optimizing Perioperative Renal Replacement Therapy for Patients Undergoing Cardiac Surgical Procedures Requiring Cardiopulmonary Bypass

Optimizing Perioperative Renal Replacement Therapy for Patients Undergoing Cardiac Surgical Procedures Requiring Cardiopulmonary Bypass

Zero balance ultrafiltration to correct metabolic alkalosis occurring during veno-arterial extracorporeal membrane oxygenation

Using Zero Balance Ultrafiltration with Dialysate as a Replacement Fluid for Hyperkalemia during Cardiopulmonary Bypass

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