title: Hemodiafiltration-A Technique for Physiological Correction of Priming Solution in Pediatric Cardiac Surgery: An In Vitro Study.
abstract: Pediatric cardiopulmonary bypass (CPB) circuit invariably requires priming with packed red blood cells (PRBCs). Metabolic composition of stored PRBCs is unphysiological and becomes worse with increasing duration of storage. It is recommended to correct these abnormalities before initiation of CPB. We tested the hypothesis that hemodiafiltration of the prime with 0.45% saline is sufficient for reducing the metabolic load and reaching a physiologic state. In an in vitro study, 100 mL of blood each from 45 units of PRBCs stored for 3-20 days were used for priming the 45 neonatal CPB circuits. Based upon the method used for removal of excess crystalloid from the prime, circuits were divided into three groups. Group 1: Direct removal through manifold line. Group 2: Ultrafiltration of prime. Group 3: Hemodiafiltration of the prime. Blood gas analyses were obtained from the PRBCs and from the prime before and after removal of crystalloid. Both direct removal of crystalloid and ultrafiltration resulted in significant reduction in biochemical and metabolic load of blood (P < 0.001). However, the final composition of the prime was far from being physiological. Hemodiafiltration resulted in improvement of metabolic parameters to near physiological range (lactate: 33.8 ± 4.44 vs. 14 ± 2.53 mg/dL, pH: 7.05 ± 0.15 vs. 7.34 ± 0.06, bicarbonates: 4.83 ± 0.59 vs. 27.6 ± 2.94 meq/L; P < 0.001). Similarly, sodium (147.76 ± 12.73 vs. 144.6 ± 5.96 meq/L) and potassium (9.6 ± 2.83 vs. 4.23 ± 0.37 meq/L) also changed significantly (P < 0.001) to near physiologic range. Hemodiafiltraion of final prime is a simple, efficients and rapid method of correcting the biochemical parameters and reducing the metabolic load of stored PRBCs towards the physiological range before initiating the CPB.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Arvind Kumar
authors.initials: AK
authors.lastname: Bishnoi
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Wadhawa
authors.affiliation: Department of Pediatric Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Jigar
authors.initials: J
authors.lastname: Surti
authors.affiliation: Department of Perfusion, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Atul
authors.initials: A
authors.lastname: Solanki
authors.affiliation: Department of Research, U. N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, 380016, Gujarat, India.
authors.forename: Komal
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Research, U.N. Mehta Institute of Cardiology and Research Center and B.J. Medical College, New Civil Hospital, Ahmedabad, Gujarat, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patel
mesh_terms: D001793:Blood Preservation; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D002648:Child; D000077324:Crystalloid Solutions; D004867:Equipment Design; D017707:Erythrocyte Transfusion / Q000295:instrumentation / Q000379:methods*; D004912:Erythrocytes / Q000378:metabolism*; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions / Q000302:isolation & purification
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: -Hemodiafiltration; -Pediatrics; -Ultrafiltration; Cardiopulmonary bypass