Improved coagulation and blood conservation in the golden hours after cardiopulmonary bypass.
The Hemobag (HB) technique allows the open-heart team to safely concentrate the residual cardiopulmonary bypass (CPB) circuit contents and return a high volume of concentrated clotting factors and blood cells back to the patient as autotransfusion. Hematocrit, platelet count, fibrinogen concentration ([Fib]), prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) were compared between two prospective convenience groups of cardiac surgical patients whose residual circuit blood was processed by the HB (n=10) or by the Cell Saver (CS; n=10) at two times after CPB: (a) after acute normovolemic hemodilution (ANH) infusion and protamine administration and (b) after admission to the intensive care unit (ICU), approximately 1 hour after CPB and HB content infusion. Minimal cell processing was also used in the HB patients to conserve blood. "Golden hours" is defined as the first few hours after CPB and protamine sulfate administration and extend into the ICU, when maintaining hemostasis is vital during cardiac surgery and is the most susceptible period for blood product administration and the opportunity to improve patient outcome. Except for PTT, all parameters changed significantly from the ANH infusion and protamine administration to approximately 1 hour after HB blood infusion and arrival in the ICU. Fibrinogen (p = .048) and hematocrit (p = .046) were significantly higher in the HB group compared with the CS group at the end of the golden hour despite infusion of significantly more allogeneic blood products (p = .070) and more washed red blood cells (RBCs; p = .001) in the CS group. All but one of the HB patients did not receive any allogeneic blood products during the golden hours. Use of the HB technique for salvaging blood is associated with significant increases in the patient's protein and cellular concentrations and lowered coagulation times in the important, first few golden hours after CPB, and except for one patient, without the addition of expensive and precarious allogeneic blood products.
Salem Hospital, Salem, Oregon, USA. srbeckmann@comcast.net
Scott R
SR
Beckmann
Dee
D
Carlile
Randall C
RC
Bissinger
M
M
Burrell
Thomas
T
Winkler
William W
WW
Shely
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000295:instrumentation; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D005260:Female; D005340:Fibrinogen; D006400:Hematocrit; D006489:Hemostatic Techniques; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011182:Postoperative Care; D011446:Prospective Studies; D011517:Prothrombin Time; D013997:Time Factors
D005340:Fibrinogen