A Novel Calculation of Priming Volume and Required Packed Cell Transfusion to Maintain Optimal Haematocrit During Cardiopulmonary Bypass

ABSTRACT

Introduction: Hemodilution during cardiopulmonarybypass is an acceptable method to avoid the complications ofcontinuous flow at the microcirculatory level. Hemodilutionalanemia during cardiopulmonary bypass can lead to inadequateoxygen delivery and, which may result in ischemic organinjury to all the organs especially to the brain, kidney, lungs andliver. Study aimed to investigate the effectiveness of a novelformula for calculating priming volume (PV) and requiredpacked cell (PC) volume to maintain optimal hematocrit levelduring cardiopulmonary bypass.Material and methods: This Prospective interventional studywas done on 150 patients who underwent open-heart surgeriesin our Institute from January 2018 to December 2018. GroupA-75 patients perfusionist’s old protocol for calculatingpriming volume and required packed cell volume calculationand the nadir hematocrit (Hct) during CPB and postoperativeoutcome monitored. Group B- 75 patients customizednovel formula was applied for calculating PV and requiredPC volume and the nadir Hct during CPB and postoperativeoutcome monitored and both the groups compared.Results: In our study results showed that maintaining optimalHct of 25% (>20%) in adult and 30% (>25%) by using ournovel customized formula for calculating prime volume andrequired packed cell volume was significantly improvedthe nadir Hct from 19.16% to 21.8% as well as average Hctvalues from 19.7% to 23.4%. Complications of Hemodilutionwere significantly reduced in the study Group B. Mortalitywas reduced to 2.7% from 5.3%. Respiratory complicationlike reintubation rate and nonfatal noncardiogenic pulmonaryedema rates reduced from 34.7% to 17%. Coagulopathy withpostoperative blood products requirement reduced from 20%to 7%.Conclusion: Our Study showed that application of this novelformula is very useful and easy for both the perfusionists andthe surgeons in maintaining optimal Hct during CPB therebyimproving the postoperative results following open heartsurgeries.