title: The 'primeless pump': a novel technique for intraoperative blood conservation.
abstract: OBJECTIVE
  Hemodilution during cardiopulmonary bypass may lead to anemia requiring intraoperative transfusions. Prime removal from the cardiopulmonary bypass circuit was used to limit dilution and intraoperative transfusions.
  
  
  METHODS
  The technique of prime removal consists of arterial and then venous side evacuation of crystalloid prior to cardiopulmonary bypass. The effectiveness of this technique, to maintain a higher hematocrit and reduce intraoperative transfusions, was studied prospectively in two consecutive groups of patients undergoing coronary revascularization (controls versus primeless).
  
  
  RESULTS
  Intraoperative hematocrits were significantly higher (P < 0.0001) and transfusions lower (4%) in the primeless versus the control group (19%) (P = 0.003). Prime removal is of particular benefit in anemic (hematocrit < or = 35%) and/or small patients (body surface area < or = 2 m2).
  
  
  CONCLUSIONS
  The technique of prime removal is simple, safe and cost-effective, reducing intraoperative transfusions, especially in small and/or anemic patients. It could be part of blood conservation strategies in most adult cardiac operations.
authors.affiliation: Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Rousou
authors.forename: R M
authors.initials: RM
authors.lastname: Engelman
authors.forename: J E
authors.initials: JE
authors.lastname: Flack
authors.forename: D W
authors.initials: DW
authors.lastname: Deaton
authors.forename: J L
authors.initials: JL
authors.lastname: Garb
authors.forename: S G
authors.initials: SG
authors.lastname: Owen
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies