Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery Subramaniam Balachandran,

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Presentation transcript:

Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery Subramaniam Balachandran, Michael H. Cross, Sivagnanam Karthikeyan, Anilkumar Mulpur, Stephen D. Hansbro, Peter Hobson, BS The Annals of Thoracic Surgery Volume 73, Issue 6, Pages 1912-1918 (June 2002) DOI: 10.1016/S0003-4975(02)03513-0

Fig 1 (A) Diagrammatic representation of the cardiopulmonary bypass (CPB) circuit used. A, B, and C show positions where clamps are removed or applied at various stages during the retrograde autologous priming process. Displacement of priming solution from the arterial line:initially clamps are positioned at A, B, and C. When the aortic cannula is connected to the arterial line, the clamp at A is removed and the aortic pressure confirmed. The clamp at position C is slowly and partially removed to allow blood to flow retrograde from the patient’s aorta into the arterial line displacing approximately 100 to 150 mL of priming solution into the prime bag. Once the arterial blood has reached the clamp at position B, the line clamp is reapplied at position A, and the clamp is removed from position B. (B) Displacement of priming solution from the venous side: once the venous line has been connected to the venous cannula, the variable occlusion clamp on the venous line is slowly released allowing venous blood to drain from the patient. At the same time, the arterial pump is slowly rotated at a sufficient flow (600 to 800 mL/min) to maintain a constant level in the venous reservoir. The venous blood slowly displaces the priming solution in the reservoir, oxygenator, and arterial line filter. Once the blood has reached the origin of the quarter-inch recirculation line, the clamp is removed from position A and reapplied at position C. The venous line is then fully opened and the pump flow is increased to establish full CPB. The Annals of Thoracic Surgery 2002 73, 1912-1918DOI: (10.1016/S0003-4975(02)03513-0)

Fig 2 The HCT values at various time periods for control and retrograde autologous priming (RAP) groups. Patients from the RAP group had higher HCT values on CPB, on admission to ITU, and at the time of hospital discharge. (CPB = cardiopulmonary bypass; HCT = hematocrit value [%]; ITU = intensive therapy unit; Pre op. = preoperative.) p < 0.05, statistically significant. The Annals of Thoracic Surgery 2002 73, 1912-1918DOI: (10.1016/S0003-4975(02)03513-0)