Modifying priming techniques in cardiopulmonary bypass circuit in known case of sickle-cell trait undergoing open...

Area of Science:

• Cardiovascular Surgery
• Hematology
• Anesthesiology

Background:

• Sickle cell disease and trait pose significant risks during cardiac surgery requiring cardiopulmonary bypass (CPB).
• Standard CPB priming techniques can exacerbate sickling complications in these patients.
• Proactive modification of CPB circuits is crucial for managing perioperative risks.

Purpose of the Study:

• To investigate the efficacy of a modified CPB priming technique in cardiac patients with sickle cell disease or trait.
• To reduce the risk of sickle cell sickling during CPB.
• To improve patient outcomes and minimize life-threatening complications.

Main Methods:

• Modified the standard heparinized crystalloid priming technique for the CPB circuit.
• Incorporated partial exchange transfusion with donor blood (packed red blood cells) and fresh frozen plasma (FFP).
• Added bicarbonate to the priming solution.

Main Results:

• The modified priming technique successfully reduced the overall sickle cell hemoglobin concentration in the blood.
• This reduction in sickle cell hemoglobin effectively lowered the risk of sickling during CPB.
• The intervention was performed without any life-threatening consequences for the patients.

Conclusions:

• Modifying CPB priming technique is a significant strategy for managing cardiac patients with sickle cell disease or trait.
• The described technique, including partial exchange transfusion and bicarbonate, offers a safer approach to CPB.
• This approach mitigates the risk of sickling and improves surgical outcomes in this vulnerable patient population.