Use of autologous blood as part of the perfusate for cardiopulmonary bypass: a priming technique

Abstract

In an attempt to replace the oncotic and protein coating capabilities of serum albumin in the perfusate, we established a priming protocol that used autologous blood as part of the perfusate solution. Prior to March 1, 1999, our standard priming protocol was 1650 ml of crystalloid with 250 ml of 5% serum albumin and 5,000 units of heparin. After removing albumin from our prime, our standard protocol was altered to include 40 ml of the patient's autologous blood in 1,800 ml of crystalloid and 10,000 units of heparin. To determine the intraoperative effects of using albumin/crystalloid primes (Group A), autologous blood/crystalloid primes (Group B) and crystalloid primes (Group C), a total of 178 patients were sequentially evaluated. Intraoperative parameters evaluated were total protein (TP), colloid osmotic pressure (COP), platelets (Plts) and fluid requirements during cardiopulmonary bypass (CPB). During an overlapping 12-month period of time, 1,092 consecutive cardiac surgical cases using CPB (584 albumin prime; 508 autologous blood prime) were evaluated for clinical outcomes in terms of mortality and length of hospitalization. In addition, over a period of 15 months, 1,458 patients in both the autologous blood/crystalloid group and the crystalloid only group were evaluated for the incidence of high-pressure excursions (HPE) after going on bypass. Comparative reviews of TP, COP and Plts demonstrated no significant difference 10 min after the start of bypass between Groups A and B. However, in Group C, there was a statistically significant increase in the intraoperative fluid requirements during CPB, compared to both of the other groups. There was no significant difference in the incidence of HPE, with an occurrence of 1.04% in the crystalloid only group and 1.11% in the autologous blood/crystalloid group. Autologous blood perfusates were identical to albumin perfusates in their platelet protection and reduction of fluid shifts during the intraoperative period.

Evaluation of Mimesys® Phosphorylcholine (PC)-Coated Oxygenators during Cardiopulmonary Bypass in Adults

“…Eighty patients (50.0%) received either Normosol R ® (Abbott Laboratories, Montreal, PQ, Canada) or Plasmalyte A ® (Baxter, USA) as a crystalloid only prime (mean 1783 ± 154 mL). Fifty-six patients (35.0%) received a combination of 50 mL autologous blood as described by Myers et al (13) and Normosol R (mean 1885 ± 91 mL). Twentyfour patients (15.0%) received a combination of 500 mL Pentaspan ® (Braun Medical, Melsunger, Germany) and Plasmalyte A (mean 1693 ± 226 mL).…”

“…Over the past several years, clinicians have attempted to use various perfusate combinations to preserve platelet protection (11)(12)(13)(14), and manufacturers have been developing polymers to solve the problem of bio-incompatibility by coating the surfaces of oxygenators and extracorporeal tubing with biopassive materials that prevent fibrinogen and platelets from reacting to their surfaces (15)(16)(17). These surface-modifying additives have taken many forms, such as Carmeda ® and Trillium ® coatings (Medtronic, Inc., Parker, CO), Duraflo II ® (Baxter Healthcare Corp., Deerfield, IL), Surface Modifying Ad-ditive ® (Cobe-Sorin, Arvada, CO), X Coating ® (Terumo Corporation, Tokyo, Japan), and Bioline ® and Safeline ® coatings (Jostra Medizintechnik, Hirrlinger, Germany) (18).…”

Optimization of cardiopulmonary bypass prime fluid to preserve microcirculatory perfusion during on-pump coronary artery bypass graft surgery: PRIME study protocol for a double-blind randomized trial

“…Crystalloids, like Ringers and lactated Ringers, lead to an increase in interstitial fluid accumulation [ 21 ]. Colloids, for example, gelofusine or hydroxyethyl starch, increase COP more than crystalloids, and subsequently reduce fluid requirements during CPB [ 22 ]. Previous studies have demonstrated that human albumin and colloids as hydroxyethyl starch prevented an increase in extravascular lung water index compared to crystalloids [ 15 , 17 ].…”

Effects of crystalloid and colloid priming strategies for cardiopulmonary bypass on colloid oncotic pressure and haemostasis: a meta-analysis

“…In contrast, priming with colloids has several advantages. Colloids containing human albumin are associated with increased COP compared to crystalloids, resulting in reduced fluid requirements during cardiac surgery with CPB [ 5 ]. Moreover, human albumin has 2 beneficial properties.…”

“…First, it protects the endothelial glycocalyx by preferentially binding to the glycocalyx, generating an endothelial surface layer [ 6 ]. Second, albumin influences haemostasis during cardiac surgery by preserving platelet count [ 5 ]. Despite these potential advantages of human albumin as a priming fluid, its cost and risk of potentially severe anaphylactic reactions limit its use [ 7 ].…”