J Extra Corpor Technol 2023 , 55 , 175 – 184 Ó The Author ( s ), published by EDP Sciences , 2023 https :// doi . org / 10.1051 / ject / 2023039
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass
Katherine Kohlsaat ( BS ) 1 , Kimberlee Gauvreau ( ScD ) 2 , 3 , Francis Fynn-Thompson ( MD ) 1 , Sharon Boyle ( RN , CCP , FPP ) 1 , Kevin Connor ( CCP , LP , FPP ) 1 , William Regan ( CCP , LP , FPP ) 1 ,* , Gregory Matte ( CCP , LP , FPP ) 1 , a ,* , and Meena Nathan ( MD , MPH ) 1 , 4 , a
1 Department of Cardiac Surgery , Boston Children ’ s Hospital , Boston , MA , USA 2 Department of Cardiology , Boston Children ’ s Hospital , Boston , MA , USA 3 Department of Biostatistics , Harvard School of Public Health , Boston , MA , USA 4 Department of Surgery , Harvard Medical School , Boston , MA , USA
Received 10 July 2023 , Accepted 5 October 2023
Abstract – Background : A standard blood prime for cardiopulmonary bypass ( CPB ) in congenital cardiac surgery may possess non-physiologic values for electrolytes , glucose , and lactate . Pre-bypass Ultrafiltration ( PBUF ) can make these values more physiologic and standardized prior to bypass initiation . We aimed to determine if using PBUF on blood primes including packed red blood cells and thawed plasma would make prime values more predictable and physiologic . Additionally , we aimed to evaluate whether the addition of PBUF had an impact on outcome measures . Methods : Retrospective review of consecutive patients 1 year of age undergoing an index cardiac operation on CPB between 8 / 2017 and 9 / 2021 . As PBUF was performed at the perfusionists ’ discretion , a natural grouping of patients that received PBUF vs . those that did not occur . Differences in electrolytes , glucose , and lactate were compared at specific time points using Fisher ’ s exact test for categorical variables and the Wilcoxon rank sum test for continuous variables . Clinical outcomes were also assessed . Results : In both cohorts , the median age at surgery was 3 months and 47 % of patients were female ; 308 / 704 ( 44 %) of the PBUF group and 163 / 414 ( 39 %) of the standard prime group had at least one preoperative risk factor . The proportion of PBUF circuits which demonstrated more physiologic values for glucose ( 318 [ 45 %]), sodium ( 434 , [ 62 %]), potassium ( 688 [ 98 %]), lactate ( 612 [ 87 %]) and osmolality ( 595 [ 92 %]) was significantly higher when compared to standard prime circuit levels for glucose ( 8 [ 2 %]), sodium ( 13 [ 3 %], potassium ( 150 [ 36 %]), lactate ( 56 [ 13 %]) and osmolality ( 23 [ 6 %]) prior to CPB initiation . There were no differences in clinical outcomes or rates of major adverse events between the two cohorts . Conclusions : PBUF creates standardized and more physiologic values for electrolytes , glucose , and lactate before the initiation of bypass without significant impacts on in-hospital outcomes .
Key words : Pre-bypass ultrafiltration , Congenital , PBUF , Electrolytes , Outcomes , Bypass prime , Blood prime , Prime .
Introduction
Blood priming a cardiopulmonary bypass ( CPB ) circuit may be necessary for cardiac surgery , especially in the neonatal and infant population . Banked blood and its component products are known to have non-physiologic values for many electrolytes , glucose , and lactate due to preservative and anticoagulant additives as well as changes that occur during refrigerated storage [ 1 ]. This can lead to undesirable hemodynamic effects once transfused [ 2 – 5 ]. Cell saver washing of packed red blood cell ( PRBC ) units has been shown to effectively control mediators of hemodynamic change seen with stored blood [ 3 – 6 ]. However , increased cell wall fragility and hemolysis after processing and during bypass may be seen [ 6 , 7 ]. This can lead to excess free iron in the blood which may then bring about oxidative stress , an increased risk of infection , and other negative outcomes [ 8 – 13 ]. It is important to note that cell-saver washing of PRBCs does not address nonphysiologic values in thawed plasma when that blood product is added to a blood prime . Pre-bypass ultrafiltration ( PBUF ) may be used to correct known issues with banked blood ( PRBCs with or without plasma ) for patients requiring a blood prime
* Corresponding author : gregory . matte @ cardio . chboston . org
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