Platelet preservation during coronary bypass surgery with bubble and membrane oxygenators: effect of albumin priming

Abstract

Sixty-three patients admitted for routine coronary bypass operations were randomized to cardiopulmonary bypass (CPB) with a membrane oxygenator (Capiox- CA) or a bubbler (Polystan or William Harvey- WH), and in the Polystan group to prime with or without albumin (P+ or P-). Platelets were counted and blood loss from the mediastinal drains during the first 12 postoperative hours was measured. The reduction in platelet numbers from baseline to closure of the sternum was significantly larger in the P- group (121 x 10⁹/l, median) than in the CA group (55 x 10⁹/l) (p <0.001), with intermediate reductions in the P+ (87 x 10⁹/l) and WH (90 x 10⁹/l) groups. The reduced platelet loss in the P+ group compared with P- was accompanied by a significant reduction in early postoperative chest tube drainage (480 versus 728 ml). Thus, precirculation of the CPB circuit with prime containing a low dose of albumin was a simple and inexpensive means of increasing platelet function with a bubble oxygenator.

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References

Woodman RC , Harker LA Bleeding complications associated with cardiopulmonary bypass. Blood 1990; 76: 1680-97.

Bagge L. , Lilienberg G. , Nyström SO , Tydén H. Coagulation, fibrinolysis and bleeding after open-heart surgery. Scand J Thorac Cardiovasc Surg 1986; 20: 15-60.

Spiess BD , Tuman KJ , McCarthy RJ , Ivankovich AD Thromboelastographic diagnosis of coagulopathies in patients undergoing cardiopulmonary bypass. Anesth Analg 1989; 68: S273 (Abstract).

Gundry Mmr , McGoon DC Bleeding patterns after open-heart surgery. J Thorac Cardiovasc Surg 1970; 60: 87-97.

Hirayama T. , Roberts DG , Allers M. , Belboul A. , Al-Khaja N. , Olsson GW Association between bleeding and reduced red cell deformability following cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg 1988; 22: 171-74.

Khuri SF , Wolfe JA , Josa M. et al. Hematologic changes during and after cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical blood loss. J Thorac Cardiovasc Surg 1992; 104: 94-107.

Vroman L. , Adams AL , Klings M. , Fischer GC , Munoz PC , Solensky RP Reactions to formed elements of blood with plasma proteins at interfaces. Ann NYAcad Sci 1977; 283: 65-76.

Salzman EW , Lindon J. , Brier D. Surface-induced platelet adhesion, aggregation, and release. Ann NY Acad Sci 1977; 283: 114-27.

Addonizio VP , Macarak EJ , Nicolaou KC , Edmunds LH , Colman RW Effects of prostacyclin and albumin on platelet loss during in vitro simulation of extracorporeal circulation. Blood 1979; 53: 1033-42.

10.

Videm V. , Fosse E. , Mollnes TE , Garred P. , Svennevig JL

Time for new concepts about measurement of complement activation by cardiopulmonary bypass?

Ann Thorac Surg 1992; 54: 725-31.

11.

Conover WJ Practical nonparametric statistics, second edition. New York: John Wiley, 1980: 229-37, 299-308,337-38.

12.

van Oeveren W. , Kazatchkine MD , Descamps-Latscha B. et al. Deleterious effects of cardiopulmonary bypass. A prospective study of bubble versus membrane oxygenation . J Thorac Cardiovasc Surg 1985 ; 89 : 888-99.

13.

Nilsson L. , Bagge L. , Nyström SO Blood cell trauma and postoperative bleeding: comparison of bubble and membrane oxygenators and observations on coronary suction. Scand J Thorac Cardiovasc Surg 1990; 24: 65-69.

14.

Benedetti M. , de Caterina R. , Bionda A. et al. Blood-artificial surface interactions during cardiopulmonary bypass. A comparative study of four oxygenators. Int JArtif Organs 1990; 13: 488-97.

15.

van den Dungen Jjam , Karliczek GF , Brenken U. , Homan van der Heide JN , Wildevuur Crh. Clinical study of blood trauma during perfusion with membrane and bubble oxygenators. J Thorac Cardiovasc Surg 1982; 83: 108-16.

16.

Edmunds LH , Ellison N. , Colman RW et al. Platelet function during cardiac operations. Comparison of membrane and bubble oxygenators. J Thorac Cardiovasc Surg 1982; 83: 805-12.