Issue |
J Extra Corpor Technol
Volume 31, Number 3, September 1999
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|
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Page(s) | 135 - 141 | |
DOI | https://doi.org/10.1051/ject/1999313135 | |
Published online | 14 August 2023 |
Original Article
Quantitative Evaluation of Heparin-Coated versus Non–Heparin-Coated Bypass Circuits During Cardiopulmonary Bypass
Division of Clinical Perfusion Education, University of Nebraska Medical Center, Omaha, Nebraska
* Address correspondence to: Alfred H. Stammers Division of Clinical Perfusion Education University of Nebraska Medical Center 985155 Nebraska Medical Center Omaha, NE 68198-5155
The extracorporealization of blood activates various elements of the fibrinolytic, coagulation, and complement systems. It is theorized that advancements in biocompatibility ameliorate many of the changes leading to improved patient management. The purpose of this study was to determine if heparin-coated circuit (HCC) utilization during cardiopulmonary bypass enhances patient outcomes in a cost-effective manner.
A search of the English medical literature was completed to identify all clinical, prospective, randomized trials comparing HCC and non-HCC in patients undergoing coronary artery bypass grafting or valvular surgery. Twenty-six papers consisting of a sample size of 1515 patients were identified and included in the study parameters. The study distinguished between Duraflo II and Carmeda coating techniques and matched papers with different heparin loading doses, as well as use of a heparin-coated cardiotomy. Study parameters were matched for all papers and analyzed according to the availability of data.
Statistically significant benefits of HCC were found in postoperative blood loss, time in the ICU, end bypass C3a, time to extubation, end bypass lactoferrin, and end platelet count, but not with respect to postoperative chest tube drainage, red blood cell transfusions, and end bypass TAT complex, D-dimers, and BTG. Data comparing the use of coated or uncoated cardiotomy utilization failed to demonstrate a benefit to heparin coating. Several immunological variables were ameliorated when Carmeda HCC was utilized, although data were insufficient to establish a cost–benefit analysis. In conclusion, heparin-coated circuitry provided statistically better results when compared to noncoated circuitry.
Key words: cardiopulmonary bypass / biocompatibility / confidence intervals / heparin coating / outcomes
© 1999 AMSECT
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