The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants Richard A Jonas, MD, David.

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Presentation transcript:

The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants Richard A Jonas, MD, David Wypij, PhD, Stephen J Roth, MD, MPH, David C Bellinger, PhD, MSc, Karen J Visconti, PhD, Adre J du Plessis, MBChB, MPH, Howard Goodkin, MD, Peter C Laussen, MD, David M Farrell, MACCP, Jodi Bartlett, RN, Ellen McGrath, RN, Leonard J Rappaport, MD, Emile A Bacha, MD, Joseph M Forbess, MD, Pedro J del Nido, MD, John E Mayer, MD, Jane W Newburger, MD, MPH The Journal of Thoracic and Cardiovascular Surgery Volume 126, Issue 6, Pages 1765-1774 (December 2003) DOI: 10.1016/j.jtcvs.2003.04.003

Figure 1 Plot of serial measurements of hematocrit levels according to perfusion phases defined as follows: 1, after induction of anesthesia; 2, administration of heparin; 3, 10 minutes after onset of cooling; 4, onset of low-flow bypass; 5, 10 minutes after onset of rewarming; 6, start of warm flow; and 7, 60 minutes off bypass. Values are depicted as the mean ± 1 SD. After adjustment for diagnostic group, statistically significant differences were found for phases 3, 4, 5, and 7. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1765-1774DOI: (10.1016/j.jtcvs.2003.04.003)

Figure 2 Plot of serial measurements of cardiac index, as determined by using the thermodilution technique. Values are depicted as the mean ± 1 SD. Not all patients had measurements in all time periods; however, only those with measurements in at least 4 time periods were included in analyses. After adjustment for diagnostic group, statistically significant differences were found at 6, 9, and 24 hours after removal of the aortic crossclamp. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1765-1774DOI: (10.1016/j.jtcvs.2003.04.003)

Figure 3 Box plots of PDI and MDI scores at age 1 year according to hematocrit group (lower hematocrit level vs higher hematocrit level at the onset of low-flow bypass). The solid bar within the box represents the median value, the upper boundary of the box represents the 75th percentile, and the lower boundary of the box represents the 25th percentile. The vertical lines extend to the 10th and 90th percentiles, with more extreme observations plotted as circles. The linear regression P values shown are for the effect of hematocrit group on outcome, with adjustment for diagnostic group. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1765-1774DOI: (10.1016/j.jtcvs.2003.04.003)

Figure 4 Scatterplot of PDI scores at age 1 year as a function of hematocrit level at the onset of low-flow bypass. The solid line was derived by means of linear regression of the data, and the dashed lines delimit the 95% confidence interval. Diagnosis was not predictive of this outcome. The linear regression P value shown is for the effect of hematocrit at the onset of low-flow bypass on outcome, with adjustment for diagnostic group. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 1765-1774DOI: (10.1016/j.jtcvs.2003.04.003)