Zelinka Edy S, Brevig James, McDonald Julie, Jin Ruyun
Advanced Perfusion Care, Inc., Pinehurst, North Carolina, USA.
J Extra Corpor Technol. 2010 Mar;42(1):45-51.
Red blood cell transfusion is associated with adverse outcomes. Transfusion practices remain varied in cardiac surgery and are a subject of growing debate. We initiated a data-driven, multidisciplinary effort to decrease allogeneic red blood cell transfusion at our institution. Creative perfusion strategies are an essential component of our program and led to a low transfusion rate. Innovations in treatment protocols were implemented and evaluated to reduce hemodilution associated with the cardiopulmonary bypass machine. Frequent review of outcomes guided our evolving clinical practice. Standardization among the perfusionists was the first step to a successful blood conservation program. Techniques included vacuum assisted venous drainage with dry 3/8" tubing, a short (10 foot) arterial-venous loop, retrograde autologous prime, and saline prime removal from the primary and cardioplegia circuit. We used a polymer-coated perfusion circuit. Hemoconcentrator and cell saver use was determined on a case-by-case basis. Normothermia was maintained except in cases of circulatory arrest or specific surgeon request. Two thousand nine hundred and seventy-nine consecutive cardiac surgical procedures (2.8% off pump coronary artery bypass) were performed from January 1, 2003 to December 31, 2008. Our overall utilization of red blood cell transfusion decreased from 43.2% to 13.6% for all patients and 38.5% to 8.7% for coronary artery bypass graft only patients. Patient outcomes were not significantly changed through 2007. Cardiopulmonary perfusion can be performed safely with low utilization of allogeneic red blood cell transfusions. Standardization and creative perfusion techniques, in the presence of a multi-faceted approach to blood management, play an important role in blood conservation.
红细胞输血与不良后果相关。心脏手术中的输血做法仍然各不相同，并且是一个争论日益激烈的话题。我们在本机构发起了一项以数据为驱动的多学科努力，以减少异体红细胞输血。创新性的灌注策略是我们方案的重要组成部分，并导致了较低的输血率。实施并评估了治疗方案的创新措施，以减少与体外循环机相关的血液稀释。对结果的频繁审查指导着我们不断发展的临床实践。灌注师之间的标准化是成功的血液保护计划的第一步。技术包括使用干式3/8英寸管道进行真空辅助静脉引流、短（10英尺）动静脉回路、逆行自体预充以及从主回路和心脏停搏回路中去除生理盐水预充液。我们使用了聚合物涂层的灌注回路。血液浓缩器和细胞回收器的使用根据具体情况确定。除循环骤停或外科医生有特殊要求的情况外，维持正常体温。从2003年1月1日至2008年12月31日，共进行了2979例连续的心脏外科手术（2.8%为非体外循环冠状动脉搭桥术）。所有患者的红细胞输血总体使用率从43.2%降至13.6%，仅冠状动脉搭桥术患者的使用率从38.5%降至8.7%。到2007年，患者的预后没有显著变化。在低异体红细胞输血使用率的情况下，可以安全地进行心肺灌注。在多方面的血液管理方法中，标准化和创新性的灌注技术在血液保护中发挥着重要作用。
