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Critical Care
Published in: Critical Care 2/2006

Open Access 01-04-2006 | Research

The impact of an hematocrit of 20% during normothermic cardiopulmonary bypass for elective low risk coronary artery bypass graft surgery on oxygen delivery and clinical outcome – a randomized controlled study [ISRCTN35655335]

Authors: Christian von Heymann, Michael Sander, Achim Foer, Anja Heinemann, Bruce Spiess, Jan Braun, Michael Krämer, Joachim Grosse, Pascal Dohmen, Simon Dushe, Jürgen Halle, Wolfgang F Konertz, Klaus-Dieter Wernecke, Claudia Spies

Published in: Critical Care | Issue 2/2006

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Abstract

Introduction

Cardiopulmonary bypass (CPB) induces hemodilutional anemia, which frequently requires the transfusion of blood products. The objective of this study was to evaluate oxygen delivery and consumption and clinical outcome in low risk patients who were allocated to an hematocrit (Hct) of 20% versus 25% during normothermic CPB for elective coronary artery bypass graft (CABG) surgery.

Methods

This study was a prospective, randomized and controlled trial. Patients were subjected to normothermic CPB (35 to 36°C) and were observed until discharge from the intensive care unit (ICU). Outcome measures were calculated whole body oxygen delivery, oxygen consumption and clinical outcome. A nonparametric multivariate analysis of variance for repeated measurements and small sample sizes was performed.

Results

In a total of 54 patients (25% Hct, n = 28; 20% Hct, n = 26), calculated oxygen delivery (p = 0.11), oxygen consumption (p = 0.06) and blood lactate (p = 0.60) were not significantly different between groups. Clinical outcomes were not different between groups.

Conclusion

These data indicate that an Hct of 20% during normothermic CPB maintained calculated whole body oxygen delivery above a critical level after elective CABG surgery in low risk patients. The question of whether a transfusion trigger in excess of 20% Hct during normothermic CPB is still supported requires a larger prospective and randomized trial.
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Literature
1.
Gordon RJ, Ravin M, Rawitscher RE, Daicoff GR: Changes in arterial pressure, viscosity, and resistance during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1975, 69: 552-561.PubMed
2.
van Bommel J, de Korte D, Lind A, Siegemund M, Trouwborst A, Verhoeven AJ, Ince C, Henny CP: The effect of transfusion of stored RBC's on intestinal microvascular oxygenation in the rat. Transfusion 2001, 41: 1515-1523. 10.1046/j.1537-2995.2001.41121515.xCrossRefPubMed
3.
Cook DJ, Oliver WC Jr, Orszulak TA, Daly RC, Bryce RD: Cardiopulmonary bypass temterature, hematocrit, and cerebral oxygen delivery in humans. Ann Thorac Surg 1995, 60: 1671-1677. 10.1016/0003-4975(95)00648-6CrossRefPubMed
4.
Vamvakas EC, Carven JH: Length of storage of transfused red cells and postoperative morbidity in patients undergoing coronary artery bypass graft surgery. Transfusion 2000, 40: 101-109. 10.1046/j.1537-2995.2000.40010101.xCrossRefPubMed
5.
Tsai AG, Cabrales P, Intaglietta M: Microvascular perfusion upon exchange transfusion with stored red blood cells in normovolemic anemic conditions. Transfusion 2004, 44: 1626-1634. 10.1111/j.0041-1132.2004.04128.xCrossRefPubMed
6.
Suttner S, Piper SN, Kumle B, Lang K, Roehm KD, Isgro F, Boldt J: The influence of allogeneic red blood cell transfusion compared with 100% oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery. Anesth Analg 2004, 99: 2-11. 10.1213/01.ANE.0000120163.44315.47CrossRefPubMed
7.
Fang WC, Helm RE, Krieger KH, Rosengart TK, DuBois WJ, Sason C, Lesser ML, Isom OW, Gold JP: Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 1997, 96: 194-199.
8.
DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, Forest RJ, Pieroni JW, Warren CS, Bogosian ME, et al.: Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 2001, 71: 769-776. 10.1016/S0003-4975(00)02393-6CrossRefPubMed
9.
Habib RH, Zacharias A, Schwann TA, Riordan CJ, Engoren M, Durham SJ, Shah A: Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med 2005, 33: 1749-1756. 10.1097/01.CCM.0000171531.06133.B0CrossRefPubMed
10.
Ehrlich MP, McCullough JN, Zhang N, Weisz DJ, Juvonen T, Bodian CA, Griepp RB: Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg 2002, 73: 191-197. 10.1016/S0003-4975(01)03273-8CrossRefPubMed
11.
Haraphongse M, Fraser RS, Rossall RE, Fisk RL, Basuldo CA, Gelfand ET, Callaghan JC: Myocardial protection during aortic valve replacement: normothermia versus hypothermia. Can J Surg 1978, 21: 101-103.PubMed
12.
Kim YD, Katz NM, Ng L, Nancherla A, Ahmed SW, Wallace RB: Effects of hypothermia and hemodilution on oxygen metabolism and hemodynamics in patients recovering from coronary artery bypass operations. J Thorac Cardiovasc Surg 1989, 97: 36-42.PubMed
13.
Tyden H: Influence of body temperature during cardiopulmonary bypass on the haemodynamics early after aorto-coronary bypass surgery. Acta Anaesthesiol Scand 1979, 23: 545-554.CrossRefPubMed
14.
The Warm Heart Investigators: Randomised trial of normothermic versus hypothermic coronary bypass surgery. Lancet 1994, 343: 559-563. 10.1016/S0140-6736(94)91519-9CrossRef
15.
Nathan HJ, Parlea L, Dupuis JY, Hendry P, Williams KA, Rubens FD, Wells GA: Safety of deliberate intraoperative and postoperative hypothermia for patients undergoing coronary artery surgery: a randomized trial. J Thorac Cardiovasc Surg 2004, 127: 1270-1275. 10.1016/j.jtcvs.2003.07.018CrossRefPubMed
16.
Cook DJ, Orszulak TA, Daly RC: Minimum hematocrit at differing cardiopulmonary bypass temperatures in dogs. Circulation 1998, 98: II170-174.PubMed
17.
Ohata T, Sawa Y, Kadoba K, Taniguchi K, Ichikawa H, Masai T, Shimazaki Y, Matsuda H: Normothermia has beneficial effects in cardiopulmonary bypass attenuating inflammatory reactions. ASAIO J 1995, 41: M288-291.CrossRefPubMed
18.
Plourde G, Leduc AS, Morin JE, DeVarennes B, Latter D, Symes J, Robbins R, Fosset N, Couture L, Ptito A: Temperature during cardiopulmonary bypass for coronary artery operations does not influence postoperative cognitive function: a prospective, randomized trial. J Thorac Cardiovasc Surg 1997, 114: 123-128. 10.1016/S0022-5223(97)70125-9CrossRefPubMed
19.
Calafiore AM, Teodori G, Mezzetti A, Bosco G, Verna AM, Di Giammarco G, Lapenna D: Intermittent antegrade warm blood cardioplegia. Ann Thorac Surg 1995, 59: 398-402. 10.1016/0003-4975(94)00843-VCrossRefPubMed
20.
Brunner E, Langer F: Non-parametric Variance Analysis of Longitudinal Data. München: R Oldenbourg. 1999.
21.
Shibutani K, Komatsu T, Kubal K, Sanchala V, Kumar V, Bizzarri DV: Critical level of oxygen delivery in anesthetized man. Crit Care Med 1983, 11: 640-643.CrossRefPubMed
22.
Mathru M, Kleinman B, Blakeman B, Sullivan H, Kumar P, Dries DJ: Myocardial metabolism and adaptation during extreme hemodilution in humans after coronary revascularization. Crit Care Med 1992, 20: 1420-1425.CrossRefPubMed
23.
Mathru M, Kleinman B, Blakeman B, Dries D, Zecca A, Rao T: Cardiovascular adjustments and gas exchange during extreme hemodilution in humans. Crit Care Med 1991, 19: 700-704.CrossRefPubMed
24.
Waxman K, Lazrove S, Shoemarker WC: Physiologic responses to operation in high risk surgical patients. Surg Gynecol Obstet 1981, 152: 633-638.PubMed
25.
Parolari A, Alamanni F, Juliano G, Polvani G, Roberto M, Veglia F, Fumero A, Carlucci C, Rona P, Brambillasca C, et al.: Oxygen metabolism during and after cardiac surgery: role of CPB. Ann Thorac Surg 2003, 76: 737-743. 10.1016/S0003-4975(03)00683-0CrossRefPubMed
26.
Spiess BD, Ley C, Body SC, Siegel LC, Stover EP, Maddi R, D'Ambra M, Jain U, Liu F, Herskowitz A, et al.: Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. The Institutions of the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. J Thorac Cardiovasc Surg 1998, 116: 460-467. 10.1016/S0022-5223(98)70012-1CrossRefPubMed
27.
Ostermann ME, Taube D, Morgan CJ, Evans TW: Acute renal failure following cardiopulmonary bypass: a changing picture. Intensive Care Med 2000, 26: 565-571. 10.1007/s001340051205CrossRefPubMed
28.
Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M: The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg 2003, 76: 784-791. 10.1016/S0003-4975(03)00558-7CrossRefPubMed
29.
Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, Djaiani G, Ivanov J, Karski J, David TE: Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005, 129: 391-400. 10.1016/j.jtcvs.2004.06.028CrossRefPubMed
30.
Bucerius J, Gummert JF, Walther T, Doll N, Falk V, Schmitt DV, Mohr FW: Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med 2004, 30: 88-95. 10.1007/s00134-003-1950-5CrossRefPubMed
31.
Paone G, Silberman NA: The paradox of on-bypass transfusion thresholds in blood conservation. Circulation 1997, 96: II-205-208.
Metadata
Title
The impact of an hematocrit of 20% during normothermic cardiopulmonary bypass for elective low risk coronary artery bypass graft surgery on oxygen delivery and clinical outcome – a randomized controlled study [ISRCTN35655335]
Authors
Christian von Heymann
Michael Sander
Achim Foer
Anja Heinemann
Bruce Spiess
Jan Braun
Michael Krämer
Joachim Grosse
Pascal Dohmen
Simon Dushe
Jürgen Halle
Wolfgang F Konertz
Klaus-Dieter Wernecke
Claudia Spies
Publication date
01-04-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc4891

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