Issue |
J Extra Corpor Technol
Volume 20, 1988
Proceedings of AmSECT’s 26th International Conference
|
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Page(s) | 84 - 88 | |
DOI | https://doi.org/10.1051/ject/198820S084 | |
Published online | 25 August 2023 |
Original Article
Lactic Acid Generation During Pediatric Cardiopulmonary Bypass: A Comparison of Blood and Crystalloid Primes
1
The Children's Hospital, Denver, CO
2
PSICOR, Inc., San Diego, CA
* Direct communications to: James S. McCormick, A.S., C.C.P., PSICOR, Inc., 16818 Via del Campo Ct., San Diego, CA 92127.
With the increasing concern over patient exposure to donor blood, we undertook a study to determine whether the exclusion of red blood cells from the pump prime for pediatric cardiopulmonary bypass surgical procedures would contribute to the development of metabolic acidosis by either decreasing O2 carrying capacity or diluting plasma buffers with a crystalloid solution. We compared a cellular (blood) prime (fresh-frozen plasma and red blood cells) and a non-cellular prime (Isolyte E and serum albumin).
Lactic acid and venous saturation levels were used to evaluate the effects of the two types of priming solutions. Lactic acid samples were drawn two minutes after bypass was initiated, and two minutes after cross clamp removal (or two minutes after bypass was resumed on circulatory arrest cases) and two minutes before discontinuing bypass. Venous saturation samples were taken at random times during the procedures. For cases using the clear prime, we were more aggressive in our blood conservation techniques.
Two-way analysis of variance revealed that there was a significant increase in lactic acid levels in both groups as a result of circulatory arrest (p = .0000000887, n = 13). There was not a significant difference in lactic acid levels between groups at any period during cardiopulmonary bypass (p =. 7756). The only differences between groups 1 (n = 15) and 2 were the bypass hematocrits, number of donor blood exposures and patient cooling times. The two-way ANOVA "Interaction" p value (p = .6117) strongly suggests that this was a clean study. These findings are supported by the comparability of the exsanguination times and venous saturations.
Our study results indicate that an Isolyte E and serum albumin prime did not increase the pediatric patient's lactic acid levels compared to a blood prime, but it does reduce patient donor blood exposure.
© 1988 AMSECT
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