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Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial

Authors

  • Richard Whitlock,

    Corresponding author
    1. Population Health Research Institute, Hamilton, Ontario, Canada
    2. Hamilton Health Sciences Center, Hamilton, Ontario, Canada
    • McMaster University, Hamilton, Ontario, Canada
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  • Joseph Mathew,

    1. McMaster University, Hamilton, Ontario, Canada
    2. Population Health Research Institute, Hamilton, Ontario, Canada
    3. Hamilton Health Sciences Center, Hamilton, Ontario, Canada
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  • John Eikelboom,

    1. McMaster University, Hamilton, Ontario, Canada
    2. Population Health Research Institute, Hamilton, Ontario, Canada
    3. Hamilton Health Sciences Center, Hamilton, Ontario, Canada
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  • Ayman Mohammad Al-Saleh,

    1. McMaster University, Hamilton, Ontario, Canada
    2. Population Health Research Institute, Hamilton, Ontario, Canada
    3. Hamilton Health Sciences Center, Hamilton, Ontario, Canada
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  • Fei Yuan,

    1. McMaster University, Hamilton, Ontario, Canada
    2. Population Health Research Institute, Hamilton, Ontario, Canada
    3. Hamilton Health Sciences Center, Hamilton, Ontario, Canada
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  • Kevin Teoh

    1. McMaster University, Hamilton, Ontario, Canada
    2. Population Health Research Institute, Hamilton, Ontario, Canada
    3. Hamilton Health Sciences Center, Hamilton, Ontario, Canada
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  • Funded internally by the Hamilton Health Sciences Center.
  • ClinicalTrials.gov Identifier: NCT01173822.

Address reprint requests to: Richard Whitlock, DBCVSRI, 237 Barton Street East, Room C1-114, Hamilton, ON, Canada, L8L 2X2; e-mail: richard.whitlock@phri.ca.

Abstract

Background

Processing residual cardiopulmonary bypass (CPB) volume via ultrafiltration may improve hemostasis and reduce transfusion through clearing activated complement, activated coagulation components, and proinflammatory cytokines. We sought to establish if processing residual CPB volume with ultrafiltration reduces homologous blood transfusion and bleeding.

Study Design and Methods

Adult patients undergoing isolated coronary artery bypass grafting (CABG) surgery were randomly assigned to receive processed (n = 99) or unprocessed (control; n = 98) residual CPB volume in this single-center randomized controlled trial. The intensive care unit team, patients, and assessors were blinded to treatment assignment and a transfusion protocol was followed. Surgeons were permitted to use retrograde autologous priming to minimize crystalloid pump prime.

Results

The processed study bag was of a smaller volume (280 [0, 550] mL vs. 590 [215, 726] mL; p < 0.01) but a higher hematocrit (29% [0%, 34%] vs. 23% [20%, 25%]; p < 0.01) than control. The rate of transfusion with homologous blood was 39% in both groups (p = 0.92). There was no difference in the volume transfused (processed 323 ± 585 mL vs. control 276 ± 520 mL; p = 0.56). There was also no difference in the proportion of patients transfused with any blood product (processed 44% vs. control 45%; p = 0.95) or in the volume of chest tube output (processed 600 [500, 940] mL vs. control 670 [490, 932] mL; p = 0.62).

Conclusion

Ultrafiltration of residual CPB volume in adults undergoing isolated CABG surgery does not reduce the need for transfusion or bleeding.

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