Intraoperative haemofiltration during on-pump cardiac surgery at Queen Alia Heart Institute
DOI:
https://doi.org/10.18203/2349-3933.ijam20240008Keywords:
Anaesthesia, Cardiac, Cardiopulmonary bypass, Extubation, HaemofiltrationAbstract
Background: Objective of the study was to determine the frequency, indications and benefits of utilizing haemofiltration during cardiopulmonary bypass in adult cardiac surgical patients.
Methods: This is a prospective observational analysis of data of adult cardiac surgical patients presented for on-pump cardiac surgery in the period between September 2023 and December 2023 at Queen Alia Heart Institute. Data was collected using Google Forms online and was subsequently recorded on Excel sheaths. Patients were divided into two groups: the haemofiltration group and the non-haemofiltration group. Both groups were compared according to perioperative laboratory and clinical variables. Statistical analysis of results using Microsoft excel followed data collection. Ethical committee approval was obtained.
Results: Data from 130 adult cardiac surgical patients (105 males and 25 females) enrolled in this analysis showed that haemofiltration was used in 25 patients (19.2%). The most frequent indication for intraoperative haemofiltration was haemodilution in 14 patients (56%). Blood transfusion was needed in 17 (68%) of patients who had haemofiltration and in 35 (33.4%) of patients who did not need haemofiltration. Patients from the haemofiltration group were extubated 5 hours earlier than patients from the non-haemofiltration group, as the duration of mechanical ventilation in the ICU was 17.9 hours in the haemofiltration group versus 24.9 hours in the non-haemofiltration group. The average overall hospital stay was 3 days less in the haemofiltration group.
Conclusions: Haemofiltration during cardiopulmonary bypass main indications were severe haemodilution, hyperkalaemia and preoperative renal impairment. The use of haemofiltration during CPB was associated with earlier tracheal extubation and shorter hospital stay.
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References
Ricci Z, Romagnoli S, Ronco C. Renal Replacement Therapy. F1000Res. 2016;5:F1000.
Gemmell L, Docking R, Black E. Renal replacement therapy in critical care. BJA Education. 2017;17(3):88-93.
Fitzgerald DJ, Cecere G. Hemofiltration and inflammatory mediators. Perfusion. 2002;23-8.
Searles B. Ultrafiltration techniques and CPB: what we know and what we think we know. J Extra Corpor Technol. 2006;38(1):64-5.
Pickering JW, James MT, Palmer SC. Acute kidney injury and prognosis after cardiopulmonary bypass: a meta-analysis of cohort studies. Am J Kidney Dis. 2015;65(2):283-93.
Soliman R, Fouad E, Belghith M, Abdelmageed T. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery. Ann Card Anaesth. 2016;19(1):45-51.
Bahrainwala ZS, Grega MA, Hogue CW, Baumgartner WA, Selnes OA, McKhann GM, et al. Intraoperative hemoglobin levels and transfusion independently predict stroke after cardiac operations. Ann Thorac Surg. 2011;91(4):1113-8.
Udzik J, Pacholewicz J, Biskupski A, Walerowicz P, Januszkiewicz K, Kwiatkowska E. Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks. J Clin Med. 2023;12(21):6894.
Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, et al. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg. 2013;2(6):717-28.
Oliver WC Jr, Nuttall GA, Orszulak TA, Bamlet WR, Abel MD, Ereth MH, et al. Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass: a prospective, randomized double-blind trial. Anesthesiology. 2004;101(2):327-39.
García-Camacho C, Marín-Paz AJ, Lagares-Franco C, Abellán-Hervás MJ, Sáinz-Otero AM. Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial. PLoS One. 2020;15(11):e0242411.
Hu J, Liu Y, Huang L, Song M, Zhu G. Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery. BMC Cardiovasc Disord. 2023;23(1):622.
Mork C, Gahl B, Eckstein F, Berdajs DA. Prolonged cardiopulmonary bypass time as predictive factor for bloodstream infection. Heliyon. 2023;9(6):e17310.
Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, Sisillo E. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22(6):814-22.
Madhavan S, Chan SP, Tan WC, Eng J, Li B, Luo HD, Teoh LK. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg (Torino). 2018;59(2):274-81.
