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Open Access 01-12-2018 | Research article

Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial

Authors: Britt Hofmann, Claudia Kaufmann, Markus Stiller, Thomas Neitzel, Andreas Wienke, Rolf-Edgar Silber, Hendrik Treede

Published in: Journal of Cardiothoracic Surgery | Issue 1/2018

Abstract

Background

Adult cardiac surgery with extracorporeal circulation is known to be associated with increased risk of blood transfusion leading to adverse outcomes. Procedures like retrograde autologous priming (RAP) may reduce these negative side effects. This randomized prospective study was initiated to assess whether RAP using specifically designed RAP bag (Terumo) has immediate effects on patient outcome.

Methods

One hundred eighteen adults undergoing elective CABG or elective aortic valve replacement were randomly assigned by a computer program into two groups: the RAP group (n = 54) in which the retrograde autologous priming was applied and the non-RAP (n = 64) group in which the same setting was used without the possibility to save priming volume. Patient demographics, preoperative characteristics and postoperative outcomes were analyzed for both groups.

Results

The primary endpoint defined as rate of intraoperative blood transfusion was significantly reduced in the RAP-group (p = 0.04). The absolute risk reduction for RAP managed patients was 13.5 percent points. There were no significant differences in operation time and blood loss. No deaths and no myocardial infarctions were observed. The number of patients needed to treat to prevent at least one red blood cell transfusion was around 8 (NNT = 7.42).

Conclusions

Retrograde autologous priming is a safe and less invasive procedure which achieves clear benefits for adult cardiac surgery patients. In the light of increasing red blood cell transfusion risks and costs and the wish of patients to avoid a transfusion implementation of retrograde autologous priming is an interesting option.

Trial registration

German Clinical Trials Register ID: DRKS00013512, registered 04 December 2017.

Likosky DS, Dickinson TA, Paugh TA. Blood conservation-a team sport. J Extra Corpor Technol. 2016;48(3):99–104.PubMedPubMedCentral

Neitzel T, Stiller M, Bushnaq H. Statistische Analyse der in Deutschland durchgeführten Perfusionen - Ergebnisse einer Umfrage 2013. Kardiotechnik. 2014;10:12–22.

Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed. J Thorac Cardiovasc Surg. 2003;125(6):1438–50.CrossRefPubMed

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(2):391–400.CrossRefPubMed

Loor G, Li L, Sabik JF 3rd, Rajeswaran J, Blackstone EH, Koch CG. Nadir hematocrit during cardiopulmonary bypass: end-organ dysfunction and mortality. J Thorac Cardiovasc Surg. 2012;144(3):654–62. e654CrossRefPubMed

Horvath KA, Acker MA, Chang H, Bagiella E, Smith PK, Iribarne A, Kron IL, Lackner P, Argenziano M, Ascheim DD, et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg. 2013;95(6):2194–201.CrossRefPubMedPubMedCentral

Teman N, Delavari N, Romano M, Prager R, Yang B, Haft J. Effects of autologous priming on blood conservation after cardiac surgery. Perfusion. 2014;29(4):333–9.CrossRefPubMed

Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg. 2013;96(2):478–85.CrossRefPubMed

Stokes EA, Wordsworth S, Bargo D, Pike K, Rogers CA, Brierley RC, Angelini GD, Murphy GJ, Reeves BC. Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial. BMJ Open. 2016;6(8):e011311.CrossRefPubMedPubMedCentral

10.

Murphy GJ, Pike K, Rogers CA, Wordsworth S, Stokes EA, Angelini GD, Reeves BC. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015;372(11):997–1008.CrossRefPubMed

11.

Honemann C, Bierbaum M, Heidler J, Doll D, Schoffski O. Costs of delivering allogenic blood in hospitals. Chirurg. 2013;84(5):426–32.CrossRefPubMed

12.

Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER, Shore-Lesserson LJ, Goodnough LT, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg. 2011;91(3):944–82.CrossRefPubMed

13.

Panico FG, Neptune WB. A mechanism to eliminate the donor blood prime from the pump-oxygenator. Surg Forum. 1960;10:605–9.PubMed

14.

Rosengart TK, DeBois W, O'Hara M, Helm R, Gomez M, Lang SJ, Altorki N, Ko W, Hartman GS, Isom OW, et al. Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements. J Thorac Cardiovasc Surg. 1998;115(2):426–38. discussion 438-429CrossRefPubMed

15.

Eising GP, Pfauder M, Niemeyer M, Tassani P, Schad H, Bauernschmitt R, Lange R. Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery. Ann Thorac Surg. 2003;75(1):23–7.CrossRefPubMed

16.

Sobieski MA 2nd, Slaughter MS, Hart DE, Pappas PS, Tatooles AJ. Prospective study on cardiopulmonary bypass prime reduction and its effect on intraoperative blood product and hemoconcentrator use. Perfusion. 2005;20(1):31–7.CrossRefPubMed

17.

Reges RV, Vicente WV, Rodrigues AJ, Basseto S, Alves Junior L, Scorzoni Filho A, Ferreira CA, Evora PR. Retrograde autologous priming in cardiopulmonary bypass in adult patients: effects on blood transfusion and hemodilution. Rev Bras Cir Cardiovasc. 2011;26(4):609–16.CrossRefPubMed

18.

Severdija EE, Heijmans JH, Theunissen M, Maessen JG, Roekaerts PH, Weerwind PW. Retrograde autologous priming reduces transfusion requirements in coronary artery bypass surgery. Perfusion. 2011;26(4):315–21.CrossRefPubMed

19.

Trapp C, Schiller W, Mellert F, Halbe M, Lorenzen H, Welz A, Probst C. Retrograde autologous priming as a safe and easy method to reduce Hemodilution and transfusion requirements during cardiac surgery. Thorac Cardiovasc Surg. 2015;63(7):628–34.CrossRefPubMed

20.

Hofmann B, Bushnaq H, Kraus FB, Raspe C, Simm A, Silber RE, Ludwig-Kraus B. Immediate effects of individualized heparin and protamine management on hemostatic activation and platelet function in adult patients undergoing cardiac surgery with tranexamic acid antifibrinolytic therapy. Perfusion. 2013;28(5):412–8.CrossRefPubMed

21.

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(2):398–402.CrossRefPubMed

22.

Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivates - 4th revised edition. Transfus Med Hemother. 2009;36(6):345–492.CrossRef

23.

Hoppe JD, Scriba PC, Kluter H. Cross-sectional guidelines for therapy with blood components and plasma derivatives (4th revised edition, 2008) - suspension of chapter 5 'Human albumin. Transfus Med Hemother. 2011;38(1):71.CrossRefPubMedPubMedCentral

24.

Muller MM, Geisen C, Zacharowski K, Tonn T, Seifried E. Transfusion of packed red cells: indications, triggers and adverse events. Dtsch Arztebl Int. 2015;112(29–30):507–17. quiz 518PubMedPubMedCentral

25.

Schechtman E. Odds ratio, relative risk, absolute risk reduction, and the number needed to treat--which of these should we use? Value Health. 2002;5(5):431–6.CrossRefPubMed

26.

Boer C, Meesters MI, Milojevic M, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2017;

27.

Pagano D, Milojevic M, Meesters MI, Benedetto U, Bolliger D, von Heymann C, Jeppsson A, Koster A, Osnabrugge RL, Ranucci M, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018;32(1):88–120. https://doi.org/10.1053/j.jvca.2017.06.026.

28.

Weltert L, Rondinelli B, Bello R, Falco M, Bellisario A, Maselli D, Turani F, De Paulis R, Pierelli L. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion. 2015;55(7):1644–54.CrossRefPubMed

29.

Hogan M, Klein AA, Richards T. The impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery. Eur J Cardiothorac Surg. 2015;47(2):218–26.CrossRefPubMed

30.

Sun P, Ji B, Sun Y, Zhu X, Liu J, Long C, Zheng Z. Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis. Perfusion. 2013;28(3):238–43.CrossRefPubMed

Title: Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial
Authors: Britt Hofmann
Claudia Kaufmann
Markus Stiller
Thomas Neitzel
Andreas Wienke
Rolf-Edgar Silber
Hendrik Treede
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2018
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-018-0739-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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