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Hemolysis during cardiopulmonary bypass
R Martin1, S McKenty, Y Thisdale
1Department of Anaesthesia, University of Sherbrooke, Canada.
Insights
Priming solutions with glucose and rapid pump acceleration significantly increase red blood cell hemolysis during cardiopulmonary bypass. Using lactated Ringer's alone or with slower acceleration reduces red blood cell trauma.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Hematology
Background:
- Red blood cell hemolysis is a significant complication during cardiopulmonary bypass (CPB).
- The composition of the priming solution and pump flow dynamics can influence red blood cell trauma.
Purpose of the Study:
- To investigate the impact of priming solution composition and initial CPB acceleration on red blood cell hemolysis.
- To identify factors contributing to red blood cell trauma during CPB.
Main Methods:
- Eighty adult patients undergoing coronary artery grafting with CPB were randomized into four groups.
- Groups differed based on priming solution (lactated Ringer's with 5% dextrose vs. lactated Ringer's alone) and initial pump flow acceleration (1 minute vs. 2 minutes).
- Plasma hemoglobin levels were measured to assess hemolysis.
Main Results:
- Plasma hemoglobin levels were four times higher in the group using lactated Ringer's with 5% dextrose and a 1-minute acceleration compared to other groups (P < 0.001).
- A significant degree of hemolysis was observed with the combination of lactated Ringer's with 5% dextrose prime and rapid pump flow initiation.
Conclusions:
- There is a significant interaction between glucose in the priming solution and the initial acceleration of CPB pump flow.
- Combining lactated Ringer's with 5% dextrose priming solution and a short time interval to full pump flow exacerbates red blood cell hemolysis.
Abstract:
Hemolysis of red blood cells is a problem during cardiopulmonary bypass. The present study was undertaken to evaluate the influence of the priming solution and of the initial acceleration of the pump on red blood cell trauma and hemolysis. Eighty adult patients undergoing coronary artery grafting with cardiopulmonary bypass (CPB) were randomly assigned to one of four groups according to the nature of the priming solution and the initial speed of CPB flow (time from the start to the full calculated flow): group 1, lactated Ringer's (LR) with 5% dextrose (5%D), 1 minute; group 2, LR5%D, 2 minutes; group 3, LR, 1 minute; group 4, LR, 2 minutes. Plasma hemoglobin was found to be 4 times higher in group 1 than in the three other groups (P less than 0.001). It is concluded that there is an interaction between the presence of glucose in the priming solution and the initial acceleration of pump flow. The combination of LR5%D prime with a short time interval to full pump flow leads to a significant degree of hemolysis.