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ICVTS on-line discussion A Minimizing CPB circuit and reducing use of homologous blood products

Bakoulev Center for Cardiovascular Surgery, Moscow 121552, Russia

Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery

eComment: Reduction of the CPB circuit and use of blood products in pediatric perfusion is possible by applying modern oxygenators, decreasing the length and diameter of tubing sets, avoiding arterial filter and optimal positioning of arterial pump with vacuum-assisted venous drainage [1, 2]. The residual volume may be processed by ultrafiltration and Cell-Saver [1].

In this article[3] the authors presented a decision of the given problem for perfusion in children with body weight <10 kg. Application of oxygenators Capiox Baby RX in the third group alone resulted in a reduction of twice the prime volume. At the same time, the usage of great amounts of RBC and FFP is noticed (303 and 251 ml respectively). That is aproximately equal to a child's circulatory blood volume in the group with a mean body weight of 5.3 kg. Compared to homologous hemotransfusion, the volume of cell savage product (56 ml) is meaningless. So the question arises of any medical or financial benefit in addition to using Cell-Saver.

From our own experience, oxygenators Capiox Baby RX – 0.5 provides short (<90 min) bloodless perfusion among children with body weight of 7–10 kg. For the last 4 years, more than 700 open heart procedures per year in children under 1 year of age have been performed at the Bakoulev Scientific Center for cardiovascular surgery.

In the same group of patients, we usually use 2 types of oxygenators Lilliput-1 (prime volume 350 ml) and Lilliput-2 (prime volume 550–600 ml). No additional modification of the CPB circuit, despite the maximal allowed shortening of tubing sets, were applied. An average amount of RBC administered during perfusion was 120–150 ml and 200–250 ml accordingly. During the postperfusional period we used the residual volume 10–15 ml/kg with the control of ACT for the correction of hemodilution and circulating blood volume. We gave up using the residual volume in the rare cases of hemolysis in this group. Unfortunately, in those cases, there was no Cell-Saver. We apply MUF in newborns and infants with body weight <5 kg, who undergo complex procedures. MUF also allows the use of the residual volume maximal completely. At the end of CPB patients had Ht of 28–30 % and by the end of surgical correction – 30–34%. Patients who underwent short perfusion usually did not need any additional RBC transfusions after CPB and during the first 24 h in ICU. Among natural colloids in this group, FFP was preferred. The average volume of FFP added during CPB was 150–180 ml. During rewarming, routinely 10% albumin (30–70 ml) was added. It was possible to use FFP after heparin neutralization by protamine (not more than 50 ml of FFP).

The bloodless perfusion should be a preferable technique for most of the patients [4]. The prospective study by the authors will determine an optimal combination of the methods and so will more effectively reducing hemotransfusion in newborns and infants compared to presented results.

	References

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1. Groom RC, Froebe S, Martin J, Manfra MJ, Cormack JE, Morse C, Taenzer AH, Quinn RD. Update on pediatric perfusion practice in north America: 2005 Survey. JECT 2005; 37:343–350.
2. Merkle F, Boettcher W, Schulz F, Koster A, Huebler M, Hetzer . Perfusion technique for nonhaemic cardiopulmonary bypass prime in neonates and infants under 6 kg body weight. Perfusion 2004; 19:229–237.[Abstract/Free Full Text]
3. Golab HD, Takkenberg JJM, van Gerner-Weelink GL, Wijers MJ, Scohy TV, de Jong PL, Bogers AJJC. Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery. Interact CardioVasc Thorac Surg 2007; 6:335–339.[Abstract/Free Full Text]
4. Cooley DA, Burnett CM. Considerations in the surgical treatment of congenital heart disease in children of Jehovah's Witnesses. Tex Heart Inst J 1992; 19:3156–159.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Zaharchenko, A. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Zaharchenko, A. Related Collections Related Article