Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial

Abstract

BackgroundAdult cardiac surgery with extracorporeal circulation is known to be associated with increased risk of blood transfusion leading to adverse outcomes. Procedures like retrograde autologous priming (RAP) may reduce these negative side effects. This randomized prospective study was initiated to assess whether RAP using specifically designed RAP bag (Terumo) has immediate effects on patient outcome.MethodsOne hundred eighteen adults undergoing elective CABG or elective aortic valve replacement were randomly assigned by a computer program into two groups: the RAP group (n = 54) in which the retrograde autologous priming was applied and the non-RAP (n = 64) group in which the same setting was used without the possibility to save priming volume. Patient demographics, preoperative characteristics and postoperative outcomes were analyzed for both groups.ResultsThe primary endpoint defined as rate of intraoperative blood transfusion was significantly reduced in the RAP-group (p = 0.04). The absolute risk reduction for RAP managed patients was 13.5 percent points. There were no significant differences in operation time and blood loss. No deaths and no myocardial infarctions were observed. The number of patients needed to treat to prevent at least one red blood cell transfusion was around 8 (NNT = 7.42).ConclusionsRetrograde autologous priming is a safe and less invasive procedure which achieves clear benefits for adult cardiac surgery patients. In the light of increasing red blood cell transfusion risks and costs and the wish of patients to avoid a transfusion implementation of retrograde autologous priming is an interesting option.Trial registrationGerman Clinical Trials Register ID: DRKS00013512, registered 04 December 2017.

The effect of various blood management strategies on intraoperative red blood cell transfusion in first-time coronary artery bypass graft patients

“…A recent study that has shown AP is a cost-effective method that reduces RBC transfusion, with a minimum displaced volume of 350 mL. 8 In this study, survey respondents reported that AP was used 87.1% versus 72.4% in LT and HT groups, respectively, with more than double the number of centers in the HT group not using AP compared to the LT. When AP was used, the average volumes were approximately 190 mL greater in the LT then HT patients.…”

“…The use of AP and ANH during cardiac surgery are especially attractive blood management interventions since they reduce both hemodilution and RBC transfusion. 8,17 We have shown that the combination of these two modalities are volume dependent with the greatest benefit seen when ANH volumes exceeded 350 mL. 17 Furthermore, there was a gender-specific effect on Hct, with women showing greater drops in Hct at similar removed volumes than men.…”

“…During this time, clinicians have access to a wide array of interventions that affect fluid balance optimizing oxygen delivery and maintaining coagulation and hemostasis. [7][8][9][10][11] The application of these techniques are not universally accepted, and when applied, may vary among institutions. Such variations may influence RBC transfusion.…”

Albumin Use After Cardiac Surgery

“…Hemodilution resulting in low hematocrit levels during CPB is known to be responsible for impaired hemostasis. Retrograde autologous priming (RAP) is a technique that may reduce hemodilution and subsequently reduce transfusion requirement and possibly bleeding ( 40 ). RAP is not used at our institution and, therefore, we cannot comment on the effect of RAP on the decision to use albumin postoperatively.…”

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

“…La aplicación de medidas de recebado sanguíneo del circuito basan su beneficio en la reducción de la agresión hemodilucional al paciente por medio del desplazamiento de la solución cristaloide que compone el cebado inicial del circuito con sangre autóloga del paciente, reduciendo así la transfusión de concentrados de hematíes y las complicaciones perioperatorias 257 . El Purgado Autólogo Retrógrado (RAP), así como el Recebado Anterógrado Hemático (HAR) cuentan con el máximo nivel de recomendación y evidencia para reducir la exposición a hemoderivados y sus complicaciones en el postoperatorio temprano y hasta el alta 250,252 . 87.…”