title: Minimizing the perfusion system by integration of the components. Does it affect the hematocrit drop and transfused red blood cells? A retrospective audit.
abstract: BACKGROUND
  We evaluate the affect on the hematocrit (Hct) drop and the amount of transfused red blood cells (RBCs) during cardiopulmonary bypass (CPB) in adult cardiac surgery patients due to minimizing the CPB circuit by using integrated components.
  
  
  METHODS
  Two hundred and seventy-two patients were included in this retrospective audit. Patients were assigned to three cohorts: the first cohort consisted of patients operated on with a CPB circuit volume of 1630 ml in 2008; the second cohort of such patients in 2010, with 1380 ml; and the third cohort of such patients in 2011, with 1250 ml.
  
  
  RESULTS
  There were no significant differences with respect to patient demographics. The priming volume was consecutively significantly reduced; (1635 ± 84 ml, 1384 ± 72 ml and 1256 ± 130 ml, p<0.0001). A trend of decreased amount of RBCs during CPB was visible (cohort 1630: 98 ± 195 ml, cohort 1380: 35 ± 151 ml and cohort 1250: 48 ± 113 ml, p=0.02). Also, the amount of RBCs during the total CPB procedure shows a decreased trend (cohort 1630: 122 ± 230 ml, cohort 1380: 52 ± 180 ml and cohort 1250: 71 ± 156 ml, p=0.04). Blood loss during CPB was significantly lower in cohorts 1380 and 1250 (1630: 922 ± 378 ml, 1380: 706 ± 347 ml and 1250: 708 ± 418 ml, p<0.0001). The volume of diuresis was significantly larger in cohort 1630 (1630: 1166 ± 800 ml, 1380: 477 ± 530 ml and 1250: 523 ± 504 ml, p<0.0001). The Hct drop at the start and end of CPB was significantly reduced comparing cohort 1630 with cohort 1250 (1630: 32 ± 7%, 1380: 30 ± 7% and 1250: 28 ± 10%, p=0.002) at the start of CPB and (1630: 31 ± 7%, 1380: 29 ± 7% and 1250: 28 ± 8%, p=0.016) at the end of CPB. The Hct values at the start and end of CPB were significantly different between the cohorts (1680: 0.23 ± 0.03 L/L - 0.22 ± 0.02 L/L, 1380: 0.25 ± 0.03 L/L - 0.25 ± 0.03 L/L and 1250: 0.25 ± 0.03 L/L- 0.25 ± 0.03 L/L, p= 0.001 and 0.0001).
  
  
  CONCLUSIONS
  Minimizing our CPB circuit by using integrated components has affected the drop of Hct and the amount of transfused RBCs.
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands Division Extra-Corporeal Circulation, Erasmus MC, Rotterdam, the Netherlands r.boks@erasmusmc.nl.
authors.forename: R H
authors.initials: RH
authors.lastname: Boks
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands Division Extra-Corporeal Circulation, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Pelt
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: J J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies
keywords: CPB circuit; blood transfusion; hematocrit; priming volume; red blood cells