title: Retrograde autologous priming of the cardiopulmonary bypass circuit: safety and impact on postoperative outcomes.
abstract: OBJECTIVE
  Retrograde autologous priming (RAP) is a blood conservation technique used to limit the severity of hemodilution during cardiopulmonary bypass and reduce perioperative transfusions. The aim of this investigation was to examine the safety of RAP and to determine the effect of RAP on adverse outcomes after cardiac surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Five hundred fifty-nine undergoing cardiopulmonary bypass.
  
  
  METHODS
  Data were retrospectively collected on 2 cohorts of adult cardiac surgical patients operated on by a single surgeon. In the RAP group (n = 256), outcome data were analyzed on all subjects over a 2-year period during which RAP was used routinely. This group was compared with a similar cohort of patients undergoing cardiopulmonary bypass over a 2-year period immediately before the introduction of RAP into the clinical practice (no-RAP group, n = 287).
  
  
  RESULTS
  In-hospital mortality was not significantly different between the RAP group (2.7%) and the no-RAP group (3.8%, p = 0.636). The incidence of postoperative cardiac arrest was significantly less in the RAP group (1 patient) compared to the no-RAP group (9 patients, p = 0.040). There were no differences between the 2 groups in the incidence of several other postoperative complications, including postoperative delirium (1.6% RAP v 3.1% no RAP), heart block (1.6% RAP v 4.2% no RAP), atrial fibrillation (19.1% RAP v 22.7% no RAP), and requiring postoperative ventilation >24 hours (2.7% RAP v 5.2% no RAP).
  
  
  CONCLUSIONS
  The authors observed no evidence of any increase in adverse events in the RAP group of this retrospective cohort study, but they did observe a decrease in the incidence of postoperative cardiac arrest in the RAP group. These findings suggest that RAP is a safe technique and may have a beneficial effect on postoperative outcomes.
authors.affiliation: Department of Anesthesiology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA. gmurphy@enh.org
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: Nick
authors.initials: N
authors.lastname: DeMuro
authors.forename: William J
authors.initials: WJ
authors.lastname: Hoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006438:Hemodilution / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome