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Lowest safe hematocrit level on cardiopulmonary bypass in patients undergoing coronary artery bypass grafting
Anna DiMarco1, Héctor Vélez, Ernesto SoItero
1Department of Internal Medicine, Hospital Damas, Ponce, Puerto Rico. di_marco_a@yahoo.com
Insights
The lowest safe hematocrit level during coronary artery bypass grafting (CABG) surgery on cardiopulmonary bypass (CPB) is 19%. This finding helps identify patients who may not require blood transfusions and avoid postoperative complications.
Area of Science:
- Cardiothoracic Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Coronary artery bypass grafting (CABG) is a common cardiothoracic procedure.
- Cardiopulmonary bypass (CPB) used during CABG can lead to hemodilution and affect hemostasis.
- Blood transfusions during CABG are associated with increased morbidity and mortality, particularly in women.
Purpose of the Study:
- To determine the lowest safe hematocrit level during CPB in CABG surgery.
- To identify patients who can undergo CABG without transfusion and without postoperative complications.
Main Methods:
- Inpatient record review of 136 first-time, single CABG patients.
- Analysis of socio-demographic data, pre-pump and on-pump hematocrit values, and red blood cell transfusion administration.
- Evaluation of postoperative complications.
Main Results:
- 68% of patients experienced no postoperative complications.
- In the non-complicated group, 40% were non-transfused.
- The non-complicated, non-transfused group had an average hematocrit of 25.1% +/- 2.8, with a minimum of 19% (P = 0.003).
- Transient acute renal insufficiency was the most common complication.
Conclusions:
- The lowest safe hematocrit level for non-complicated, non-transfused CABG patients is 19% (average 25.1% +/- 2.8).
- Preoperative patient profiling (age, weight, height, BSA, BMI, hematocrit values) can assist medical staff in transfusion decision-making.
Unlabelled:
Coronary artery bypass grafting (CABG) is the most common cardiothoracic surgical procedure performed in the United States. The majority of patients undergoing CABG are placed on cardiopulmonary bypass (CPB) to support the circulation. CPB hemodilutes the patient imposing extremes in the hemostatic system, requiring careful assessment of pre-surgical hematologic values. Recent clinical data suggests that patients who receive blood transfusions while hospitalized for CABG have an increased morbidity and mortality. Women have a greater risk of transfusions than men with CABG and are thus at greater postoperative risk. The purpose of the present study was to determine the lowest safe hematocrit level achievable on CPB during CABG surgery where no transfusion and no post-operative complications were identified.
Methods:
Inpatient record review evaluation including socio-demographic data, hematocrit values (pre-pump and on pump), red blood cell transfusion administration and Surgery, postoperative complications.
Results:
Collected data from 136 first-time, single CABG patients demonstrated 68% had no postoperative complications. Of this non-complicated group 60% were transfused while only 40% were non-transfused. The non-complicated, non-transrusea group nematocrit vaiues averagea 25.1% +/- 2.8 with a minimum of 19%. (P = 0.003). 68% of the patients had no postoperative complication. Transient acute renal insufficiency was the most common complication observed.
Conclusion:
The lowest safe hematocrit level on CABG in non-complicated and non-transfused patients was 19% corresponding to an average of 25.1% +/- 2.8. A preoperative patient profile has been identified where age, weight, height, BSA, BMI, and pre-pump and on pump hematocrit values can aid medical staff about transfusion decision making.
