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Bicarbonate buffered ultrafiltration leads to a physiologic priming solution in pediatric cardiac surgery

^a Klinik fuer Anaesthesiologie und Intensivmedizin, OE 8050, Medizinische Hochschule Hannover, Carl- Neuberg- Str.1, D- 30625, Hannover, Germany
^b Klinik fuer Herz-, Thorax-, Transplantations- und Gefaeßchirurgie, Medizinische Hochschule Hannover, Hannover, Germany

Corresponding author. Tel.: +49 511 532 9088; fax: +49 511 532 9048.

E-mail address: Osthaus.Alexander{at}MH-Hannover.de (W.A. Osthaus).

Pediatric cardiopulmonary bypass (CPB) involves a high ratio of priming blood volume to patient blood volume. The composition of packed red blood cells (RBCs) is very unphysiological in terms of acid-base, electrolyte and metabolite values. Therefore, we tested the hypothesis whether ultrafiltration of the prime and replacement with bicarbonate buffered hemofiltration solution (BB-HS) is sufficient for reducing the metabolic load and reaching a physiologic state. For planned surgery of congenital heart defects with cardiopulmonary bypass, 20 CPB circuits were primed with BB-HS, gelatin and 1 unit of RBCs. The fluid was hemofiltrated using an ultrahemofilter at 300 ml/min until approximately 1000 ml of ultrafiltrate was restored with BB-HS. Blood gas analyses were obtained from the priming blood, once before and once after bicarbonate buffered ultrafiltration (BBUF). The measured substrates decreased significantly (P<0.001) after BBUF (glucose from 13.0±2.6 to 6.3±1.0 and lactate from 3.8±1.5 to 2.3±1.0 mmol/l). Acid-base parameters increased (P<0.001) to normal or high normal values (pH from 7.01±0.09 to 7.68±0.12; HCO₃ from 12.1±2.4 to 25.4±3.6 mmol/l and BE from –15.4±3.6 to –0.8±3.7 mmol/l). Even the electrolytes sodium, potassium and calcium changed significantly (P<0.001) toward the physiologic range. BBUF is an efficient method of reducing the metabolic load of priming. After BBUF, even the electrolyte and acid-base balance reached a physiologic state, which is important for minimizing electrolyte and acid-base disturbances after initiation of CPB.

Key Words: Cardiopulmonary bypass; Congenital heart disease; Ultrafiltration; Priming volume; Metabolic load

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				W. Osthaus, H Gorler, J Sievers, N Rahe-Meyer, J Optenhofel, T Breymann, G Theilmeier, and R Suempelmann Bicarbonate-buffered ultrafiltration during pediatric cardiac surgery prevents electrolyte and acid-base balance disturbances Perfusion, January 1, 2009; 24(1): 19 - 25. [Abstract] [PDF]