Issue |
J Extra Corpor Technol
Volume 18, Number 4, December 1986
|
|
---|---|---|
Page(s) | 200 - 209 | |
DOI | https://doi.org/10.1051/ject/1986184200 | |
Published online | 29 August 2023 |
Original Article
Blood Conservation during Open Heart Surgery: A Literature Review
Department of Cardiac Surgery, Baystate Medical Center, Springfield, MA
* Direct communications to: Roger A. Vertrees, C.C.P., Department of Cardiac Surgery, Baystate Medical Center, 759 Chestnut St., Springfield, MA 01199
(J. Extra-Corpor. Technol. 18[4] p.198–207 Winter 1986, 74 refs.) Due to the increase of cardiac surgery and cardiopulmonary bypass procedures (CBP) in recent years, tremendous demands have been placed on local blood banking facilities. As a consequence, methods to conserve blood during CPB have proliferated. Indeed, through the many innovations in technique and technology, blood usage has been curtailed to a fraction of what it was less than a decade ago. Oschner et al. report that in 1981, on average, 1.8 units of blood were used per patient per hospital stay, in contrast to approximately 8 units used in 1975. The Cleveland Clinic reports that by the year 1983 average blood usage per patient per hospital stay had decreased to 0.8 units. These numbers show a sharp improvement over the 5-8 units of blood required simply to “prime the pump” in the late sixties and early seventies.
A number of technologies are responsible for this drastic reduction in homologous blood requirements during CPB. More efficient oxygenators, for example, have contributed to lengthened red cell survival. Improved biomaterials have substantially increased the survival of platelets and leukocytes. Prebyass autologous blood withdrawal techniques, which can protect up to 20% of the patient’s blood volume from the ravages of CPB, have been used. Autotrans-fusion devices, which reclaim blood that otherwise would be lost, process it, and then return it to the circulation in a usable form, have also found significant use. The development of molecules of heparin and protamine of increased purity has provided greater control over the coagulation cascade, especially when used in conjunction with activated clotting time and heparin-protamine titration tests. An important development in blood conservation has been that of hemodilution.
Key words: homologous blood transfusion / autotransfusion / hemodilution / prime solutions / anticoagulation / centrifugation / hemofiltration
© 1986 AMSECT
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