K . Kohlsaat et al .: J Extra Corpor Technol 2023 , 55 , 175 – 184 181
Table
5 . Last CPB laboratory values .
|
Standard Prime ( n = 417 ) |
PBUF ( n = 704 ) |
P value |
pH on CPB 1 |
7.40 [ 7.37 , 7.44 ] |
7.40 [ 7.37 , 7.44 ] |
0.66 |
Na + ( mmol / L ) |
141 [ 139 , 144 ] |
140 [ 138 , 143 ] |
0.11 |
Glucose ( mg / dL ) ( n = 416 , 704 ) |
181 [ 153 , 212 ] |
170 [ 141 , 197 ] |
< 0.001 |
K + ( mmol / L ) ( n = 417 , 700 ) |
3.8 [ 3.5 , 4.2 ] |
3.9 [ 3.5 , 4.2 ] |
0.14 |
Ca ++ ( mmol / L ) ( n = 416 , 704 ) |
1.23 [ 1.09 , 1.37 ] |
1.21 [ 1.08 , 1.33 ] |
0.029 |
Lactate ( mmol / L ) ( n = 406 , 699 ) |
2.1 [ 1.5 , 3.0 ] |
1.9 [ 1.5 , 2.9 ] |
0.12 |
OSM ( mOsm / kg H 2 O ) ( n = 416 , 704 ) |
292 [ 287 , 297 ] |
290 [ 285 , 296 ] |
0.001 |
Values shown are number ( percent ) or median [ 25th , 75th percentiles ]. 1 pH on bypass was measured at 37 ° C ( alpha-stat ) for all cases performed at > 30 ° C . pH on bypass was measured at the target temperature
( pH-stat ) for all cases 30 ° C . CPB : cardiopulmonary bypass ; dL : deciliters ; kg : kilograms ; L : liters ; mg : milligrams ; mmol : millimoles ; mOsm : milliosmoles ; OSM : osmolality ; PBUF : pre-bypass ultrafiltration .
Table 6 . Clinical outcomes .
|
Standard prime ( n = 417 ) |
PBUF ( n = 704 ) |
P value |
Time to first extubation 1 ( hours ) |
50 [ 22 , 124 ] |
49 [ 21 , 127 ] |
0.96 |
CICU LOS ( days ) |
5 [ 2 , 11 ] |
5 [ 2 , 13 ] |
0.64 |
Postoperative hospital LOS ( days ) |
12 [ 6 , 23 ] |
12 [ 7 , 27 ] |
0.49 |
Unplanned reoperation ( n = 416 , 703 ) |
41 ( 10 %) |
63 ( 9 %) |
0.67 |
Re-exploration for bleeding ( n = 417 , 702 ) |
6 ( 1 %) |
12 ( 2 %) |
0.81 |
Mediastinitis ( n = 417 , 703 ) |
2 ( 1 %) |
5 ( 1 %) |
1.0 |
CNS complication |
11 ( 3 %) |
9 ( 1 %) |
0.11 |
ECMO |
19 ( 5 %) |
22 ( 3 %) |
0.25 |
Pacemaker |
14 ( 3 %) |
21 ( 3 %) |
0.73 |
Mortality |
15 ( 4 %) |
26 ( 4 %) |
1.0 |
Values shown are number ( percent ) or median [ 25th , 75th percentiles ]. 1 Begins at start of bypass .
CICU : cardiac intensive care unit ; CNS : central nervous system ; ECMO : extracorporeal membrane oxygenation ; LOS : length of stay ; PBUF : pre-bypass ultrafiltration .
Figure 2 . Total hospital length of stay . Distribution of total hospital lengths of stay is displayed as a box and whisker plot for both the standard prime and PBUF cohorts . The lower and upper borders of the box represent the 25th and 75th percentiles . The middle horizontal lines represent the median ( Standard Prime = 15 , PBUF = 16 ). The lower and upper whiskers represent the minimum and maximum values of non-outliers , while extra dots represent outliers . While Group PBUF exhibits a smaller range , there is no statistically significant difference between the two cohorts . is measurable in a blood gas result , there are many other aspects addressed with our blood product preparations . Of note , our PRBC units are leukocyte-reduced , resulting in the patient being exposed to no more than 5,000,000 white blood cells ( WBCs ) per unit , per the American Association of Blood Banks ( AABB ) standards . This mitigates the incidence of febrile nonhemolytic transfusion reactions ( FNHTRs ) and transfusionrelated acute lung injury ( TRALI ) which can be of significant benefit to morbidity and mortality scores [ 23 ]. Additionally , our RBC units are irradiated to 25 Gray units ( Gy ) in order to deactivate transfused lymphocytes and reduce the possibility of transfusion-associated graft versus host disease ( TA-GVHD ). Further , it is assumed that as a unit of blood ages , the activated neutrophils will continue to release their contents regardless of all preservative efforts including addition of Adsol and cold preservation [ 23 ]. In combination with leukocyte reduction , mitigating the deleterious impacts caused by the unavoidable exposure to activated WBCs should enhance recovery times by lessening endothelial dysfunction , complement activation , and the inflammatory response [ 23 ].
The use of a balanced electrolyte solution along with 0.45 % saline during PBUF accomplishes two main objectives . One is to aid in the normalization of measured blood chemistry values ,