Retrograde autologous priming to reduce allogeneic blood transfusion requirements: a systematic review

Abstract

Background: Efforts have been made to minimize transfusion of packed red blood cells in patients undergoing cardiac surgery with cardiopulmonary bypass. One method concerns retrograde autologous priming. Although the technique has been used for decades, results remain contradictory in terms of transfusion requirements. Objective: This systematic literature review aimed to summarize the evidence for the efficacy of retrograde autologous priming in terms of decreasing perioperative packed red blood cell requirements in adults. Methods: Two researchers independently searched PubMed for articles published in the past 10 years. The modified Cochrane collaboration Risk of Bias Tool and the Research Triangle Institute Item Bank were used to assess bias. Results: Eight studies were included, of which two randomized and six observational studies. Five studies, including one randomized study, report a significant decrease in packed red blood cell use in the retrograde autologous priming group compared to no retrograde autologous priming used. All studies are flawed by at least a high risk bias of bias score on one item of the bias assessment. Conclusion: Although most studies reported significantly fewer packed red blood cell transfusions in the retrograde autologous priming group, it is important to note that relatively few articles are available which are flawed by several types of bias. Prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of retrograde autologous priming.

Effect of retrograde autologous priming on lactate and hemoglobin levels of adult patients undergoing coronary artery bypass grafting

“…6 It has been observed that RAP treated patients had less intraoperative transfusions but there was no statistically significant difference in lactate levels between the two groups. [7][8][9][10][11][12] In our study we observed that RAP technique is not only helpful in maintaining the Hb levels but also helps to maintain lower lactate levels in patients undergoing CABG on CPB. Although the difference between the mean Hb and lactate levels among the two groups was not statistically significant before CPB, there was a significant change in these parameters among both groups upon weaning.…”

“…[5][6][7][8][9] Many methods and drugs like remifentanil, thiamine have been investigated to reduce lactate levels on CPB. [10][11][12] As the effects of RAP are mainly studied in terms of intra operative blood transfusion requirements and no sufficient or inconclusive evidence is present regarding its effects on patients' lactate levels, [2][3][4][5][6][7][13][14][15][16] we aimed to study the effect of RAP on lactate levels of the patient as a primary outcome and the Hb levels as a secondary outcome. as both of these parameters effect the postoperative outcome of patients undergoing coronary artery bypass grafting (CABG).…”

Adult cardiopulmonary bypass in Australian and New Zealand public hospitals: A survey of practice

“…In keeping with contemporary evidence-based guidelines, this review concluded that overall, the available evidence supports the use of RAP as a blood-conservation technique. 1,18 The authors of the review also reported that all studies concluding that RAP did not reduce the need for allogenic blood transfusion used markedly greater net prime volumes following RAP than the positive trials. 17 Patients who are anaemic or have a smaller body surface area are likely to benefit the most from efforts to minimise haemodilution.…”

“…17 Patients who are anaemic or have a smaller body surface area are likely to benefit the most from efforts to minimise haemodilution. 1,19 There is a considerable body of evidence supporting the practice of reducing net prime volume (and haemodilution) through circuit componentry selection and use of RAP; 17,18 however, the scale and design of existing studies has generally limited the ability to control the full range of confounding variables affecting volume status. 1,4 In comparison to a survey of perfusion equipment used in Australian and New Zealand hospitals in 2003 (which included private hospitals), the use of CPs as the main arterial pump appears to have increased slightly (28% in current survey versus 13.6% in the 2003 survey).…”

Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side

“…Minimally invasive extracorporeal circuits (MiECC) and repriming techniques like retrograde autologous priming (RAP) have been strongly recommended for bloodsaving (1,4,5). However, methodological weakness in current studies and heterogeneity between authors in the application of both are a matter of concern (6)(7)(8)(9)(10)(11) about it´s beneficial effect in terms of the whole process.…”