title: Lowest safe hematocrit level on cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.
abstract: Coronary artery bypass grafting (CABG) is the most common cardiothoracic surgical procedure performed in the United States. The majority of patients undergoing CABG are placed on cardiopulmonary bypass (CPB) to support the circulation. CPB hemodilutes the patient imposing extremes in the hemostatic system, requiring careful assessment of pre-surgical hematologic values. Recent clinical data suggests that patients who receive blood transfusions while hospitalized for CABG have an increased morbidity and mortality. Women have a greater risk of transfusions than men with CABG and are thus at greater postoperative risk. The purpose of the present study was to determine the lowest safe hematocrit level achievable on CPB during CABG surgery where no transfusion and no post-operative complications were identified.
  
  
  METHODS
  Inpatient record review evaluation including socio-demographic data, hematocrit values (pre-pump and on pump), red blood cell transfusion administration and Surgery, postoperative complications.
  
  
  RESULTS
  Collected data from 136 first-time, single CABG patients demonstrated 68% had no postoperative complications. Of this non-complicated group 60% were transfused while only 40% were non-transfused. The non-complicated, non-transrusea group nematocrit vaiues averagea 25.1% +/- 2.8 with a minimum of 19%. (P = 0.003). 68% of the patients had no postoperative complication. Transient acute renal insufficiency was the most common complication observed.
  
  
  CONCLUSIONS
  The lowest safe hematocrit level on CABG in non-complicated and non-transfused patients was 19% corresponding to an average of 25.1% +/- 2.8. A preoperative patient profile has been identified where age, weight, height, BSA, BMI, and pre-pump and on pump hematocrit values can aid medical staff about transfusion decision making.
authors: Department of Internal Medicine, Hospital Damas, Ponce, Puerto Rico. di_marco_a@yahoo.com
authors: Anna
authors: A
authors: DiMarco
authors: Héctor
authors: H
authors: Vélez
authors: Ernesto
authors: E
authors: SoItero
authors: Miguel
authors: M
authors: Magraner
authors: Rafael
authors: R
authors: Bredy
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D016063:Blood Loss, Surgical; D001827:Body Height; D001835:Body Weight; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006400:Hematocrit; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies