ABSTRACT
BACKGROUND: We hypothesized that normothermic cardiopulmonary bypass (CPB) would be associated with decreased blood loss and allogeneic transfusion requirements relative to hypothermic CPB. METHODS: After obtaining institutional review board approval and informed patient consent, we conducted a prospective, randomized study of 79 patients undergoing CPB for a primary cardiac operation at normothermic (37 degrees C) (n = 44) or hypothermic temperature (25 degrees C) (n = 35). Blood loss and transfusion requirements in the operating room and for the first 24 hours in the intensive care unit were determined. A paired t test and rank sum tests were used. A p value of less than 0.05 was considered significant. RESULTS: The normothermic and hypothermic CPB groups did not differ in demographic variables, CPB or cross-clamp duration, heparin sodium or protamine sulfate dose, prothrombin time, or thromboelastogram results. There were no differences between the two CPB groups in blood loss or transfusion requirements. CONCLUSIONS: We found that when there was no difference in duration of CPB, normothermic and hypothermic CPB groups demonstrated similar blood loss and transfusion requirements even though other studies have shown hypothermia induces platelet dysfunction and alters the activity of the coagulation cascade.
Subject(s)
Blood Transfusion , Cardiopulmonary Bypass/methods , Temperature , Adult , Aged , Blood Coagulation , Blood Loss, Surgical , Body Temperature , Cardiac Surgical Procedures , Cardiopulmonary Bypass/adverse effects , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
A databank search was performed and 148 consecutive patients (mean age 59.5 +/- 10.4 years) were identified who underwent emergency coronary artery bypass surgery at the Mayo Clinic between November 20, 1979, and February 12, 1992, immediately after unsuccessful coronary angioplasty. At the end of the angioplasty procedure, there was no anterograde coronary blood flow in the treated artery in 54%, ongoing chest pain in 78%, and hemodynamic compromise requiring intravenous vasopressor therapy in 25% of patients; 127 patients (86%) had at least 1 of these adverse characteristics. After leaving the catheterization laboratory, the median time to arrival in the operating room was 12 minutes. Median time from arrival in the operating room to initiation of cardiopulmonary bypass was 86 minutes, to administration of cardioplegia was 98 minutes, and to removal of the aortic cross-clamp was 135 minutes. In-hospital mortality was 11%, and 18% developed nonfatal Q-wave myocardial infarction. Thus, significant time is required to achieve surgical reperfusion after unsuccessful coronary angioplasty.
