We have located links that may give you full text access.
Journal Article
Observational Study
The Unintended Consequences of Over-Reducing Cardiopulmonary Bypass Circuit Prime Volume.
Annals of Thoracic Surgery 2017 June
BACKGROUND: The Society of Thoracic Surgeon blood conservation guidelines recommend minimizing cardiopulmonary bypass circuit prime volume (PV) as an integral, evidence-based (Class I, Level A) blood conservation strategy. We used a large, multiinstitutional registry to evaluate the effectiveness of restricting cardiopulmonary bypass PV on intraoperative red blood cell (RBC) transfusion.
METHODS: We reviewed 47,273 isolated coronary artery bypass graft procedures performed among 189 institutions between April 2012 and May 2015. The primary outcome was intraoperative transfusion of at least 1 unit RBC; the secondary outcome was intraoperative transfusion of 4 or more units RBC. We estimated the adjusted odds of each transfusion type using separate multivariable logistic regression models that controlled for 13 confounding factors. The effect of PV on odds of transfusion was modeled using restricted cubic splines to assess possible nonlinearity.
RESULTS: We found a statistically significant nonlinear pattern in the relation between PV and odds of transfusion of both 1 or more units RBC (χ2 = 116.3, df = 4, p < 0.001) and 4 or more units RBC (χ2 = 25.9, df = 4, p < 0.001). The lowest probability of transfusion of 1 or more units RBC was estimated at a ratio of PV to estimated blood volume of 0.152 (p < 0.001).
CONCLUSIONS: Efforts to minimize PV below 15% of a patient's estimated blood volume do not protect patients from intraoperative RBC transfusion, and may increase exposure. Prime volume can affect both patient morbidity and the economic impact associated with blood utilization. Further studies on the effect of PV on blood transfusion are warranted.
METHODS: We reviewed 47,273 isolated coronary artery bypass graft procedures performed among 189 institutions between April 2012 and May 2015. The primary outcome was intraoperative transfusion of at least 1 unit RBC; the secondary outcome was intraoperative transfusion of 4 or more units RBC. We estimated the adjusted odds of each transfusion type using separate multivariable logistic regression models that controlled for 13 confounding factors. The effect of PV on odds of transfusion was modeled using restricted cubic splines to assess possible nonlinearity.
RESULTS: We found a statistically significant nonlinear pattern in the relation between PV and odds of transfusion of both 1 or more units RBC (χ2 = 116.3, df = 4, p < 0.001) and 4 or more units RBC (χ2 = 25.9, df = 4, p < 0.001). The lowest probability of transfusion of 1 or more units RBC was estimated at a ratio of PV to estimated blood volume of 0.152 (p < 0.001).
CONCLUSIONS: Efforts to minimize PV below 15% of a patient's estimated blood volume do not protect patients from intraoperative RBC transfusion, and may increase exposure. Prime volume can affect both patient morbidity and the economic impact associated with blood utilization. Further studies on the effect of PV on blood transfusion are warranted.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app