Purpose:

Hemodilution during cardiopulmonary bypass may lead to anemia requiring intraoperative transfusions. Prime removal from the cardiopulmonary bypass circuit was used to limit dilution and intraoperative transfusions.

Methods:

The technique of prime removal consists of arterial and then venous side evacuation of crystalloid prior to cardiopulmonary bypass. The effectiveness of this technique, to maintain a higher hematocrit and reduce intraoperative transfusions, was studied prospectively in two consecutive groups of patients undergoing coronary revascularization (controls versus primeless).

Results:

Intraoperative hematocrits were significantly higher (P < 0.0001) and transfusions lower (4%) in the primeless versus the control group (19%) (P = 0.003). Prime removal is of particular benefit in anemic (hematocrit ≤ 35%) and/or small patients (body surface area ≤ 2 m²).

Conclusion:

The technique of prime removal is simple, safe and cost-effective, reducing intraoperative transfusions, especially in small and/or anemic patients. It could be part of blood conservation strategies in most adult cardiac operations.

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