title: The failure of retrograde autologous priming of the cardiopulmonary bypass circuit to reduce blood use after cardiac surgical procedures.
abstract: Hemodilution during cardiopulmonary bypass (CPB) is a primary risk factor for blood transfusion in cardiac surgical patients. Priming of the CPB circuit with the patients' own blood (retrograde autologous priming, RAP) is a technique used to limit hemodilution and reduce transfusion requirements. We designed this study to examine the impact of RAP on perioperative blood product use. Using a retrospective cohort study design, the medical records of all patients undergoing CPB (excluding circulatory arrest cases) by a single surgeon were examined. Data were collected over a 24-mo period when RAP was routinely used as a blood conservation strategy (RAP group, n = 257). This group was compared with a cohort of patients during the 24 mo immediately preceding the introduction of RAP into clinical practice (no RAP group, n = 288). A small, statistically insignificant reduction in the percentage of patients receiving packed red blood cells was observed in the RAP group (44% versus 51% no RAP, P = 0.083). No differences were found between the groups in the number of units of packed red blood cells, platelets, or fresh frozen plasma transfused throughout the perioperative period. These results suggest that overall, RAP does not offer a clinically important benefit as a blood conservation technique.
  
  
  CONCLUSIONS
  Priming of the cardiopulmonary bypass circuit with the patients' own blood (retrograde autologous priming) resulted in insignificant reductions in blood use in a large, unselected group of patients undergoing cardiac surgical procedures.
authors.affiliation: Department of Anesthesiology, Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA. dgmurphy@core.com
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Szokol
authors.forename: Martin
authors.initials: M
authors.lastname: Nitsun
authors.forename: David A
authors.initials: DA
authors.lastname: Alspach
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avram
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Vender
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Votapka
authors.forename: Todd K
authors.initials: TK
authors.lastname: Rosengart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D003422:Critical Care; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies; D018570:Risk Assessment