Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery?

Eising, Gregory P.; Pfauder, Martin; Niemeyer, Markus; Tassani, Peter; Schad, H.; Bauernschmitt, Robert; Lange, Rüdiger

doi:10.1016/s0003-4975(02)04099-7

Cited by 45 publications

(56 citation statements)

References 11 publications

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“…Patients in the RAP group had a higher haematocrit on bypass and fewer patients needed transfusion of PRBC, which is in accordance with findings by other investigators [7][8][9][10][11][12][13] . Although the NON-RAP group counted more female patients, who have a predetermined higher transfusion risk as compared to male patients, both bivariate and multivariate logistic regression analysis indicated a prominent effect of RAP on transfusion of PRBC.…”

Section: Discussionsupporting

confidence: 91%

“…A higher haematocrit was observed on CPB in the RAP group as compared to the NON-RAP group ( Table 2), which is in accordance with findings by other investigators. The lowest haematocrit levels on CPB vary from 22 to 29% in 'RAP groups' to as low as 20 to 26% in the 'control groups' [7][8][9][10][11][12][13] . The literature provides increasing evidence that a low haematocrit is associated with increased postoperative morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

et al. 2011

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The hypothesis was tested whether retrograde autologous priming (RAP) of the cardiopulmonary bypass system, compared to a standard primed system (NON-RAP group), results in less haemodilution and less transfusion of packed red blood cells. Retrospectively, data was collected from the medical charts of one hundred patients undergoing elective coronary artery bypass grafting using cardiopulmonary bypass. Fifty patients where RAP was used have been compared to fifty patients using NON-RAP. The prime volume in the NON-RAP group was 1,627±108 mL versus 782±96 mL in the RAP group (p<0.001). The lowest haematocrit during perfusion was 22% in the NON-RAP group versus 26% when the RAP technique was used (p<0.001). In the NON-RAP group, 26% of the patients received packed red cells in contrast to 6% in the RAP group (p<0.012). A positive association was found between RAP and less transfusion of packed red blood cells (p<0.012). In conclusion, retrograde autologous priming, reducing the prime volume of the cardiopulmonary bypass system, causes less haemodilution and reduces intraoperative transfusion of packed red blood cells.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

et al. 2011

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“…The meta-analysis 8 of the six randomised controlled trials [2][3][4][5][6][7] investigating RAP showed a 64% reduction (odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.13-0.94, p=0.04) in the need for the use of blood intraoperatively and a 74% reduction (OR: 0.26, 95% CI: 0.13-0.52, p=0.0001) in the need for blood during a hospital stay. The mean intraoperative fluid balance was not significantly different in RAP patients (1,574.6ml) compared with the control groups (2,016.2ml) (p=0.44).…”

Section: Discussionmentioning

confidence: 99%

Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts

Kearsey

Thekkudan

Robbins

et al. 2013

annals

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INTRODUCTION Currently, around 35-80% of patients undergoing cardiac surgery in the UK receive a blood transfusion. Retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit has been suggested as a possible strategy to reduce blood transfusion during cardiac surgery. METHODS Data from 101 consecutive patients undergoing isolated coronary artery bypass grafts (where RAP was used) were collected prospectively and compared with 92 historic patients prior to RAP use in our centre. RESULTS Baseline characteristics (ie age, preoperative haemoglobin [Hb] etc) were not significantly different between the RAP and non-RAP groups. The mean pump priming volume of 1,013ml in the RAP group was significantly lower (p<0.001) than that of 2,450ml in the non-RAP group. The mean Hb level at initiation of bypass of 9.1g/dl in patients having RAP was significantly higher (p<0.001) than that of 7.7g/dl in those who did not have RAP. There was no significant difference between the RAP and non-RAP groups in transfusion of red cells, platelets and fresh frozen plasma, 30-day mortality, re-exploration rate and predischarge Hb level. The median durations of cardiac intensive care unit stay and in-hospital stay of 1 day (interquartile range [IQR]: 1-2 days) and 5 days (IQR: 4-6 days) in the RAP group were significantly shorter than those of the non-RAP group (2 days [IQR: 1-3 days] and 6 days [IQR: 5-9 days]). CONCLUSIONS In the population group studied, RAP did not influence blood transfusion rates but was associated with a reduction in duration of hospital stay.

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“…Early investigators had demonstrated that an inverse linear relationship exists between temperature and blood viscosity, since blood viscosities can increase 10% to 30% under the hypothermic conditions associated with CPB Therefore, moderate hemodilution during CPB has been considered desirable in avoiding this increased viscosity and potential microcirculation damage, and such a degree of hemodilution has generally been provided by a total crystalloid prime [12]. A second theoretical risk of RAP is related to the potential of hemodynamic instability caused by the large volumes of crystalloid solution withdrawn during the RAP process [10]. It is somewhat unexpected in considering the relative hypovolemia induced by RAP that a significant volume or pressor requirement was not subsequently observed in patients subjected to RAP.…”

Section: Discussionmentioning

confidence: 99%

“…The original RAP method, described by Rosengart et al [7], modified by Eising et al [10], as follows, was adopted in this investigation (Figure 1 mmHg, using small doses of intravenously administered phenylephrine. A recirculation bag was connected to the venous line.…”

Section: Methods Of the Retrograde Autologous Priming (Rap)mentioning

confidence: 99%

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Reges¹,

Vicente²,

Rodrigues³

et al. 2011

Rev Bras Cir Cardiovasc

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Introduction: Retrograde autologous priming (RAP) is a cardiopulmonary bypass (CPB) method, at low cost. Previous studies have shown that this method reduces hemodilution and blood transfusions needs through increased intraoperative hematocrit.Objective: To evaluate RAP method, in relation to standard CPB (crystalloid priming), in adult patients.Methods: Sixty-two patients were randomly allocated to two groups: 1) Group RAP (n = 27) of patients operated using the RAP and; 2) Control group of patients operated using CPB standard crystalloid method (n = 35). The RAP was performed by draining crystalloid prime from the arterial and venous lines, before CPB, into a collect recycling bag. The main parameters analyzed were: 1) CPB hemodynamic data; 2) Hematocrit and hemoglobin values; 3) The need for blood transfusions.Results: It was observed statistically significant fewer transfusions during surgery and reduced CPB hemodilution using RAP. The CPB hemodynamic values were similar, observing a tendency to use lower CPB flows in the RAP group patients.Conclusion: This investigation was designed to be a small-scale pilot study to evaluate the effects of RAP, which were demonstrated concerning the CPB hemodilution and blood transfusions.

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Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery?

Cited by 45 publications

References 11 publications

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery

Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

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