Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass
Background: A standard blood prime for cardiopulmonary bypass (CPB) in congenital cardiac surgery may possess non-physiologic values for electrolytes, glucose, and lactate. Pre-bypass Ultrafiltration (PBUF) can make these values more physiologic and standardized prior to bypass initiation. We aimed...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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EDP Sciences
2023-12-01
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| Series: | The Journal of ExtraCorporeal Technology |
| Subjects: | |
| Online Access: | https://ject.edpsciences.org/articles/ject/full_html/2023/04/ject230032/ject230032.html |
| _version_ | 1827160931109437440 |
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| author | Kohlsaat Katherine Gauvreau Kimberlee Fynn-Thompson Francis Boyle Sharon Connor Kevin Regan William Matte Gregory Nathan Meena |
| author_facet | Kohlsaat Katherine Gauvreau Kimberlee Fynn-Thompson Francis Boyle Sharon Connor Kevin Regan William Matte Gregory Nathan Meena |
| author_sort | Kohlsaat Katherine |
| collection | DOAJ |
| description | Background: A standard blood prime for cardiopulmonary bypass (CPB) in congenital cardiac surgery may possess non-physiologic values for electrolytes, glucose, and lactate. Pre-bypass Ultrafiltration (PBUF) can make these values more physiologic and standardized prior to bypass initiation. We aimed to determine if using PBUF on blood primes including packed red blood cells and thawed plasma would make prime values more predictable and physiologic. Additionally, we aimed to evaluate whether the addition of PBUF had an impact on outcome measures. Methods: Retrospective review of consecutive patients ≤ 1 year of age undergoing an index cardiac operation on CPB between 8/2017 and 9/2021. As PBUF was performed at the perfusionists’ discretion, a natural grouping of patients that received PBUF vs. those that did not occur. Differences in electrolytes, glucose, and lactate were compared at specific time points using Fisher’s exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Clinical outcomes were also assessed. Results: In both cohorts, the median age at surgery was 3 months and 47% of patients were female; 308/704 (44%) of the PBUF group and 163/414 (39%) of the standard prime group had at least one preoperative risk factor. The proportion of PBUF circuits which demonstrated more physiologic values for glucose (318 [45%]), sodium (434, [62%]), potassium (688 [98%]), lactate (612 [87%]) and osmolality (595 [92%]) was significantly higher when compared to standard prime circuit levels for glucose (8 [2%]), sodium (13 [3%], potassium (150 [36%]), lactate (56 [13%]) and osmolality (23 [6%]) prior to CPB initiation. There were no differences in clinical outcomes or rates of major adverse events between the two cohorts. Conclusions: PBUF creates standardized and more physiologic values for electrolytes, glucose, and lactate before the initiation of bypass without significant impacts on in-hospital outcomes. |
| first_indexed | 2024-03-07T21:37:09Z |
| format | Article |
| id | doaj.art-0223bc08d6864d51a9b8bc6bd94fcb42 |
| institution | Directory Open Access Journal |
| issn | 0022-1058 2969-8960 |
| language | English |
| last_indexed | 2025-03-21T00:20:51Z |
| publishDate | 2023-12-01 |
| publisher | EDP Sciences |
| record_format | Article |
| series | The Journal of ExtraCorporeal Technology |
| spelling | doaj.art-0223bc08d6864d51a9b8bc6bd94fcb422024-08-03T08:08:51ZengEDP SciencesThe Journal of ExtraCorporeal Technology0022-10582969-89602023-12-0155417518410.1051/ject/2023039ject230032Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypassKohlsaat Katherine0Gauvreau Kimberlee1Fynn-Thompson Francis2Boyle Sharon3Connor Kevin4Regan William5Matte Gregory6https://orcid.org/0000-0001-8113-0314Nathan Meena7Department of Cardiac Surgery, Boston Children’s HospitalDepartment of Cardiology, Boston Children’s HospitalDepartment of Cardiac Surgery, Boston Children’s HospitalDepartment of Cardiac Surgery, Boston Children’s HospitalDepartment of Cardiac Surgery, Boston Children’s HospitalDepartment of Cardiac Surgery, Boston Children’s HospitalDepartment of Cardiac Surgery, Boston Children’s HospitalDepartment of Cardiac Surgery, Boston Children’s HospitalBackground: A standard blood prime for cardiopulmonary bypass (CPB) in congenital cardiac surgery may possess non-physiologic values for electrolytes, glucose, and lactate. Pre-bypass Ultrafiltration (PBUF) can make these values more physiologic and standardized prior to bypass initiation. We aimed to determine if using PBUF on blood primes including packed red blood cells and thawed plasma would make prime values more predictable and physiologic. Additionally, we aimed to evaluate whether the addition of PBUF had an impact on outcome measures. Methods: Retrospective review of consecutive patients ≤ 1 year of age undergoing an index cardiac operation on CPB between 8/2017 and 9/2021. As PBUF was performed at the perfusionists’ discretion, a natural grouping of patients that received PBUF vs. those that did not occur. Differences in electrolytes, glucose, and lactate were compared at specific time points using Fisher’s exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Clinical outcomes were also assessed. Results: In both cohorts, the median age at surgery was 3 months and 47% of patients were female; 308/704 (44%) of the PBUF group and 163/414 (39%) of the standard prime group had at least one preoperative risk factor. The proportion of PBUF circuits which demonstrated more physiologic values for glucose (318 [45%]), sodium (434, [62%]), potassium (688 [98%]), lactate (612 [87%]) and osmolality (595 [92%]) was significantly higher when compared to standard prime circuit levels for glucose (8 [2%]), sodium (13 [3%], potassium (150 [36%]), lactate (56 [13%]) and osmolality (23 [6%]) prior to CPB initiation. There were no differences in clinical outcomes or rates of major adverse events between the two cohorts. Conclusions: PBUF creates standardized and more physiologic values for electrolytes, glucose, and lactate before the initiation of bypass without significant impacts on in-hospital outcomes.https://ject.edpsciences.org/articles/ject/full_html/2023/04/ject230032/ject230032.htmlpre-bypass ultrafiltrationcongenitalpbufelectrolytesoutcomesbypass primeblood primeprime |
| spellingShingle | Kohlsaat Katherine Gauvreau Kimberlee Fynn-Thompson Francis Boyle Sharon Connor Kevin Regan William Matte Gregory Nathan Meena Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass The Journal of ExtraCorporeal Technology pre-bypass ultrafiltration congenital pbuf electrolytes outcomes bypass prime blood prime prime |
| title | Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass |
| title_full | Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass |
| title_fullStr | Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass |
| title_full_unstemmed | Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass |
| title_short | Impact of pre-bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass |
| title_sort | impact of pre bypass ultrafiltration on prime values and clinical outcomes in neonatal and infant cardiopulmonary bypass |
| topic | pre-bypass ultrafiltration congenital pbuf electrolytes outcomes bypass prime blood prime prime |
| url | https://ject.edpsciences.org/articles/ject/full_html/2023/04/ject230032/ject230032.html |
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