Retrograde Autologous Priming For Cardiopulmonary Bypass: A Safe And Effective Means Of Decreasing Hemodilution And Transfusion Requirements Todd K.

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Presentation transcript:

Retrograde Autologous Priming For Cardiopulmonary Bypass: A Safe And Effective Means Of Decreasing Hemodilution And Transfusion Requirements Todd K. Rosengart, MD, William DeBois, BS, CCP, Maureen O'Hara, RN, Robert Helm, MD, Maureen Gomez, RN, Samuel J. Lang, MD, Nasser Altorki, MD, Wilson Ko, MD, Gregg S. Hartman, MD, O.Wayne Isom, MD, Karl H. Krieger, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 2, Pages 426-439 (February 1998) DOI: 10.1016/S0022-5223(98)70287-9 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1A Schema of the RAP technique. 1, Arterial line drainage. While systolic arterial blood pressure is being maintained greater than 100 mm Hg, the recirculation line clamp is slowly released, and blood travels through the pump arterial line from the aorta though the filter, into the recirculation line, and up into a 1000 ml transfer bag. 2, Venous reservoir and oxygenator drainage. The line between the oxygenator and arterial line filter is clamped and the recirculation line is unclamped. The arterial pump is slowly advanced until the venous reservoir volume drops to 200 ml. At this time, the arterial line filter purge is opened and the arterial pump is again advanced until the fluid exiting the oxygenator outlet became sanguineous. The arterial pump is stopped and the pump outlet and recirculation lines are clamped. The recirculation line is then removed from the 1000 ml bag and attached to the recirculation port on the oxygenator reservoir. 3, Venous line drainage. As bypass is commenced, the venous line prime is drained into the recirculation bag, and this ¼-inch line is clamped once the venous line fluid becomes sanguineous. The recirculation bag is rehung to allow for crystalloid transfusion as necessary. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1B Detailed schema of drainage of arterial line. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1C Detailed schema of venous reservoir and oxygenator. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1D Detailed schema of venous line. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 A, Mean arterial pressure at various time points in RAP and non-RAP groups. B, Systemic vascular resistance at various time points in RAP and non-RAP groups. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Serial hematocrit values at various time points in RAP and non-RAP groups. POD, Postoperative day. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Serial hematocrit values at various time points in RAP and non-RAP groups, “corrected” for homologous blood transfusions (three percentage points were subtracted from the hematocrit value for each unit of homologous red blood cells transfused to that time interval). POD, Postoperative day. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 426-439DOI: (10.1016/S0022-5223(98)70287-9) Copyright © 1998 Mosby, Inc. Terms and Conditions