Autologous blood sequestration using a double venous reservoir bypass circuit and polymerized hemoglobin prime.
Cardiac surgery often necessitates transfusion of homologous blood. Hemoglobin based oxygen carrying solutions (HBOCs) transport oxygen, suggesting use in cardiopulmonary bypass. HBOC was used in a novel oxygenator double-reservoir circuit that permits acute sequestration of a portion of the autologous blood volume during bypass. Two groups of seven mongrel dogs each were studied in an experimental bypass model using global myocardial ischemia and cardioplegia protection: HBOC group, initial venous return drained to a separate reservoir and hypothermic bypass was conducted with HBOC containing perfusate in a second bypass reservoir; Control group, crystalloid prime in a conventional circuit. Hemodynamics and metabolic and hematologic parameters were measured before and 60 min after aortic clamp removal and reinfusion of sequestered autologous blood. Blood gases, base excess, hematocrit, total hemoglobin, and platelet counts were measured. In the HBOC group, metabolic acidosis did not occur, and ventricular function was preserved. Net conservation of platelets was noted at study conclusion: control 33+/-13 x 10(3) per mm3 versus HBOC 48+/-13 x 10(3), p < 0.05. HBOC based priming in a double venous reservoir system permits bypass at very low hematocrit, with preservation of cardiac function. Net conservation of the platelet mass occurs, a portion of which is not exposed to the deleterious effects of hypothermia and cardiopulmonary bypass.
Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114-2696, USA.
Siyamek
S
Neragi-Miandoab
J Luis
JL
Guerrero
Gus J
GJ
Vlahakes
D000818:Animals; D001802:Blood Substitutes / Q000008:administration & dosage*; D001810:Blood Volume; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004285:Dogs; D006400:Hematocrit; D006454:Hemoglobins / Q000008:administration & dosage*; D010106:Oxygenators; D019106:Postoperative Hemorrhage / Q000517:prevention & control
D001802:Blood Substitutes; D006454:Hemoglobins