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A target-orientated algorithm for regional citrate-calcium anticoagulation in extracorporeal therapies
M Brandl1, K Strobl, J Hartmann
1Center for Biomedical Technology, Danube University Krems, Krems, Austria. martin.brandl @ donau-uni.ac.at
Background:
Citrate anticoagulation offers several advantages in comparison to conventional anticoagulation. Most algorithms for regional citrate-calcium anticoagulation are based on citrate and calcium chloride infusion coupled in a fixed proportion to the blood flow without considering the hematocrit (Hct)/plasma flow or the filter clearance of citrate and calcium.
Methods:
The aim of this study was to develop an algorithm for optimized citrate anticoagulation in extracorporeal therapies such as dialysis. A mathematical model was developed to calculate the volume of citrate infusion required to achieve a desired ionized calcium (iCa) target level in the extracorporeal circuit and to restore the total calcium level to a physiological value.
Results:
The model was validated by correlation analyses for different blood Hct values and shows an excellent fit to the laboratory measurements.
Conclusion:
The results for both iCa target concentrations, namely those after citrate and calcium infusion, proved that the software algorithm adapts well to variable treatment parameters.
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