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A prospective, randomized study of cardiopulmonary bypass temperature and blood transfusion
P E Stensrud1, G A Nuttall, M A de Castro
1Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. stensrud.paul@mayo.edu
Insights
Normothermic cardiopulmonary bypass (CPB) did not reduce blood loss or transfusion needs compared to hypothermic CPB in cardiac surgery. This study found no significant differences between the two CPB methods.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Hypothermia during cardiopulmonary bypass (CPB) may impair coagulation and platelet function.
- Normothermic CPB is hypothesized to reduce blood loss and transfusion requirements.
Purpose of the Study:
- To compare blood loss and allogeneic transfusion requirements between normothermic and hypothermic CPB.
Main Methods:
- A prospective, randomized study of 79 patients undergoing primary cardiac operations with CPB.
- Patients were assigned to either normothermic (37°C) or hypothermic (25°C) CPB.
- Blood loss and transfusion needs were assessed in the operating room and for 24 hours postoperatively.
Main Results:
- No significant differences in demographic variables, CPB duration, or coagulation parameters were observed.
- Blood loss and allogeneic transfusion requirements were similar between the normothermic and hypothermic CPB groups.
- No differences were found in CPB or cross-clamp duration, or in administered doses of heparin or protamine.
Conclusions:
- Normothermic CPB did not demonstrate an advantage over hypothermic CPB in reducing blood loss or transfusion needs.
- These findings contrast with other studies suggesting hypothermia's negative impact on coagulation.
- Further research may be needed to elucidate the precise effects of CPB temperature on hemostasis.
Background:
We hypothesized that normothermic cardiopulmonary bypass (CPB) would be associated with decreased blood loss and allogeneic transfusion requirements relative to hypothermic CPB.
Methods:
After obtaining institutional review board approval and informed patient consent, we conducted a prospective, randomized study of 79 patients undergoing CPB for a primary cardiac operation at normothermic (37 degrees C) (n = 44) or hypothermic temperature (25 degrees C) (n = 35). Blood loss and transfusion requirements in the operating room and for the first 24 hours in the intensive care unit were determined. A paired t test and rank sum tests were used. A p value of less than 0.05 was considered significant.
Results:
The normothermic and hypothermic CPB groups did not differ in demographic variables, CPB or cross-clamp duration, heparin sodium or protamine sulfate dose, prothrombin time, or thromboelastogram results. There were no differences between the two CPB groups in blood loss or transfusion requirements.
Conclusions:
We found that when there was no difference in duration of CPB, normothermic and hypothermic CPB groups demonstrated similar blood loss and transfusion requirements even though other studies have shown hypothermia induces platelet dysfunction and alters the activity of the coagulation cascade.