The effect of bloodless pump prime on cerebral oxygenation in paediatric patients.
BACKGROUND
In paediatric patients, crystalloid prime for cardiopulmonary bypass (CPB) causes further haemodilution in comparison with blood-containing prime. Thus it may affect the cerebral oxygen supply/demand balance. The purpose of the study was to compare the effect of bloodless pump prime with that of blood-containing prime on cerebral oxygenation in children.


METHODS
Thirty-six paediatric patients scheduled for elective repair of atrial or ventricular septal defect were enrolled. In Group C (n = 18), the CPB circuit was primed only with crystalloid. In Group B (n = 18), red blood cells were added to achieve a haematocrit (Hct) of 20% during CPB. The regional cerebral oxygen saturation (rSO(2)) value measured by near-infrared spectroscopy was compared between the two groups.


RESULTS
In both groups, rSO(2) decreased below baseline at the start of CPB and during rewarming (P < 0.001, for both groups during each period). At the start of CPB, haemodilution was greater in Group C than in Group B (Hct 16.1 +/- 0.7% vs. 20.7 +/- 0.5%; P < 0.01), and there was a greater reduction in rSO(2) in Group C (49.0 +/- 5.4% vs. 59.2 +/- 7.0%; P < 0.01). During rewarming, rSO(2) was significantly lower in Group C than in Group B (57.8 +/- 5.3% vs. 62.8 +/- 6.2%; P < 0.01).


CONCLUSIONS
In paediatric patients, the haemodilution associated with crystalloid priming causes a greater reduction in rSO(2) than with blood-containing prime at the starting period of CPB and the rewarming period.
Han
S H
SH
Department of Anaesthesiology, Seoul National University, Bundang Hospital, Seoul, Korea.
Kim
C S
CS
Kim
S D
SD
Bahk
J H
JH
Park
Y S
YS
D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature / Q000502:physiology; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D000077324:Crystalloid Solutions; D004912:Erythrocytes / Q000502:physiology; D005260:Female; D006343:Heart Septal Defects / Q000601:surgery; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007552:Isotonic Solutions; D008297:Male; D010100:Oxygen / Q000097:blood*; D010952:Plasma Substitutes / Q000008:administration & dosage*; D019265:Spectroscopy, Near-Infrared; D018709:Statistics, Nonparametric
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D010100:Oxygen