title: Initial results of an optimized perfusion system.
abstract: BACKGROUND
  In order to reduce the negative effects of extracorporeal circulation (ECC), the perfusion system and management were optimized at our institution. The goals of optimization were a reduction in the priming volume, in the foreign surface area and in microbubble activity, as well as optimization of suction blood management.
  
  
  METHODS
  Sixty patients were included in this retrospective study. Patients were assigned to two groups, with regard to the use of an optimized perfusion system (OPS-group, n=30) and a standard perfusion system (SPS-group, n=30). All patients underwent elective procedures.
  
  
  RESULTS
  There were no significant differences with respect to patient demographics and operation time. ECC time and cross-clamp time were significantly longer in the OPS group. Statistically significant differences in outcome between the two groups were seen with regard to the following variables: effective priming volume (OPS: 775±447ml; SPS: 1610±0ml; p<0.0001), hemoglobin drop after the start of ECC (OPS: 2.7±1.2g/dl; SPS: 4.2±0.8g/dl; p<0.0001), c-reactive protein on postoperative day 2 (OPS: 121.0±59.4 U/l; SPS: 164.0±50.2 U/l; p=0.003). With regard to the use of blood transfusions, a 33% reduction in the overall amount of transfused units was seen. The rate of patients without transfusions during the entire hospital stay increased from 37% (SPS) to 53% (OPS). The mean transfused red blood cell units per patient was lower in the OPS-group (1.6±2.4 units) than in the SPS-group (2.3±3.5 units).
  
  
  CONCLUSIONS
  With the described optimized perfusion system, a significantly lower priming volume, leading to less hemodilution after the onset of CPB, was achieved. The amount of blood transfusions and the inflammatory response were reduced.
authors: Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, 8091 Zurich, Switzerland. christophthomas.starck@usz.ch
authors: C T
authors: CT
authors: Starck
authors: D
authors: D
authors: Bettex
authors: C
authors: C
authors: Felix
authors: D
authors: D
authors: Reser
authors: T
authors: T
authors: Dreizler
authors: P
authors: P
authors: Hasenclever
authors: V
authors: V
authors: Falk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein
keywords: SIRS; cardiopulmonary bypass; extracorporeal circulation; optimized perfusion system; transfusion