Crosby Amanda D, Sistino Joseph J
Augusta University Medical Center, Augusta, Georgia; and.
College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
J Extra Corpor Technol. 2019 Sep;51(3):140-146.
Pre-bypass acute autologous donation (PAAD) is a method of blood conservation that reduces exposure of blood to the cardiopulmonary bypass (CPB) circuit and may prevent the contact activation of platelets and clotting factors. The purpose of this study was to evaluate the impact of PAAD on product transfusion rates in cardiac surgical patients. This is a retrospective study of patients undergoing cardiac surgery between 2015 and 2017 for either a coronary artery bypass (CABG), valve replacement, or a combined valve/CABG procedure. PAAD was performed by removing blood from the venous line of the bypass circuit immediately before the institution of CPB. The amount of PAAD volume was determined during the surgical time-out. This was based on patient size, baseline hemoglobin, and type of case. Poisson logistic regression was used to determine whether PAAD was a significant predictor for blood product transfusion. After obtaining institutional review board approval, we reviewed 236 records on (n = 154, 65.3%) who received PAAD and (n = 82, 34.7%) with no blood withdrawal before CPB. The median PAAD volume in the PAAD group was 750 mL. Patients undergoing PAAD had a 14.3% red blood cell (RBC) transfusion rate (.27 ± .91 units), and without PAAD, the RBC transfusion rate was 62.2% (1.56 ± 1.79 units). The significant ( < .05) odds ratios (ORs) for RBC transfusion were as follows: baseline hemoglobin .617 (.530-.719), PAAD .998 (.997-.999), CPB time 1.009 (1.003-1.015), age 1.034 (1.013-1.055), and BSA odds ratio (OR) .326 (.124-.857). PAAD could not be used in all patients. However, using the OR in the Poisson logistic regression model, a one-unit reduction in RBC transfusion is predicted for each 500 mL of PAAD. PAAD was also associated with a significant reduction in fresh frozen plasma and platelet transfusion.
体外循环前急性自体献血（PAAD）是一种血液保护方法，可减少血液与体外循环（CPB）回路的接触，并可能防止血小板和凝血因子的接触激活。本研究的目的是评估PAAD对心脏手术患者血液制品输注率的影响。这是一项对2015年至2017年间接受心脏手术的患者进行的回顾性研究，手术类型包括冠状动脉旁路移植术（CABG）、瓣膜置换术或瓣膜/CABG联合手术。PAAD通过在CPB开始前立即从旁路回路的静脉管路中采血来进行。PAAD的采血量在手术暂停期间确定，这基于患者体型、基线血红蛋白和病例类型。采用泊松逻辑回归来确定PAAD是否是血液制品输注的显著预测因素。在获得机构审查委员会批准后，我们审查了236份记录，其中（n = 154，65.3%）接受了PAAD，（n = 82，34.7%）在CPB前未采血。PAAD组的PAAD采血量中位数为750 mL。接受PAAD的患者红细胞（RBC）输注率为14.3%（0.27±0.91单位），未接受PAAD的患者RBC输注率为62.2%（1.56±1.79单位）。RBC输注的显著（<0.05）优势比（OR）如下：基线血红蛋白0.617（0.530 - 0.719），PAAD 0.998（0.997 - 0.999），CPB时间1.009（1.003 - 1.015），年龄1.034（1.013 - 1.055），以及体表面积优势比（OR）0.326（0.124 - 0.857）。并非所有患者都能采用PAAD。然而，使用泊松逻辑回归模型中的OR，预计每500 mL的PAAD可使RBC输注减少一个单位。PAAD还与新鲜冰冻血浆和血小板输注的显著减少相关。
