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Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehovah's Witness: a case report
A B Brest van Kempen1, J M Gasiorek, K Bloemendaal
1Department of Extracorporeal Circulation, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. r.brestvankempen@planet.nl
Insights
A novel low-prime extracorporeal circuit and autologous priming technique safely minimized hemodilution for Jehovah's Witness cardiac surgery patients, avoiding banked blood. This approach proved effective, allowing for a safe patient discharge.
Area of Science:
- Cardiovascular Surgery
- Perfusion Technology
- Transfusion Medicine
Background:
- Cardiac surgery presents unique challenges for Jehovah's Witnesses due to their refusal of banked blood transfusions.
- Minimizing hemodilution and blood loss during cardiopulmonary bypass is critical for patient safety in this population.
Observation:
- A specialized small extracorporeal circuit with a priming volume of 650 ml was designed.
- Antegrade and retrograde autologous priming techniques were employed to reduce the total priming volume to approximately 50 ml.
- Key perfusion parameters including bypass time (63 min), blood flow (5300 ml/min), and pressures were monitored.
Findings:
- The low-prime circuit and autologous priming effectively minimized hemodilution, with hematocrit levels remaining stable throughout extracorporeal circulation (ECC) and showing improvement post-operatively (40% by day 5).
- The surgical procedure was completed safely with a mean arterial pressure of 55 mmHg.
- The patient was discharged 7 days after surgery, indicating a successful clinical outcome.
Implications:
- This low-prime circuit strategy, combined with autologous priming, offers a safe and effective alternative to banked blood in cardiac surgery for Jehovah's Witnesses.
- The findings support the wider adoption of such techniques to improve surgical outcomes and reduce transfusion risks in specific patient groups.
- Further research could explore the long-term benefits and applicability of this approach in diverse surgical settings.
Abstract:
Cardiac surgery on Jehovah's Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to +/-50 ml. Bypass time was 63 min with an average blood flow of 5300+/-114 ml/min and postmembrane pressures of 180+/-45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55+/-12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.
