Zero balance ultrafiltration for the correction of acute acidosis after a period of prolonged deep hypothermic circulatory arrest

Abstract

A 36-year-old woman with normal renal function underwent a total arch replacement requiring 110 minutes of deep hypothermic circulatory arrest. Prior to rewarming, a pH of 7.063 with a base deficit of 10.8 was obtained. Zero-balance ultrafiltration (Z-BUF) was initiated during rewarming 7 minutes after resumption of cardiopulmonary bypass. After one hour (10L) of Z-BUF, all electrolyte and acid-base disturbances were fully corrected. Our case illustrates that Z-BUF offers a valuable option for the correction of severe electrolyte and acid-base disturbances in adults undergoing cardiac surgery. Its use should be considered in addition to the more standard pharmacologic approaches to such derangements as it offers rapid and predictable electrolyte and acid-base correction and potential anti-inflammatory benefits.

Keywords

zero balance ultrafiltration deep hypothermic circulatory arrest total aortic arch replacement acid-base correction PrismaSate®

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References

Journois

Israel-Biet

Pouard

. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology 1996 Nov; 85(5): 965–976.

Tallman

Dumond

Brown

. Inflammatory mediator removal by zero-balance ultrafiltration during cardiopulmonary bypass. Perfusion 2002; 17(2): 111–115.

Berdat

Eichenberger

Ebell

. Elimination of proinflammatory cytokines in pediatric cardiac surgery: analysis of ultrafiltration method and filter type. J Thorac Cardiovasc Surg 2004; 127(6): 1688–1696.

Millar

Armstrong

van der Linden

. Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass. Ann Thorac Surg 1993; 56(6): 1499–1502.

Clar

Bowers

Larson

. Derivation of sieving coefficients to determine the efficacy of the hemoconcentrator in removal of four inflammatory mediators produced during cardiopulmonary bypass. ASAIO J 1997; 43(3): 163–170.

Darling

Searles

Nasrallah

. High-volume, zero balanced ultrafiltration improves pulmonary function in a model of post-pump syndrome. J Extra Corpor Technol 2002; 34(4): 254–259.

Huang

Yao

Wang

. Continuous ultrafiltration attenuates the pulmonary injury that follows open heart surgery with cardiopulmonary bypass. Ann Thorac Surg 2003; 76(1): 136–140.