The Effect of Autologus Blood Priming on Cerebral Oximetry in Congenital Cardiac Surgery Patients

Abstract

Hemodilution is one of the sequelae of cardiopulmonary bypass (CPB). Autologous blood priming (retrograde autologous priming [RAP]/venous antegrade priming [VAP]) and acute normovolemic hemodilution (ANH) may be effective techniques to minimize hemodilution. The primary objective of this study is to investigate the impact of RAP/VAP combined with ANH on changes in cerebral saturations. A retrospective analysis of 52 patients undergoing congenital cardiac surgery requiring CPB between July 2014 and March 2015 was performed. Bivariate analysis correlated RAP/VAP and ANH volumes. SrO2 change scores were regressed on all covariates using multivariable least-squares models. The average percent of circulating blood volume (CBV) removed during RAP/VAP was 21 ± 10% in the cyanotic group and 15 ± 5% in the acyanotic group (p =.006). There was a decrease in SrO2 from 70 ± 11% at baseline to 55 ± 13% at CPB initiation, although this decrease did not differ by cyanosis (p = .668) or use of ANH (p = .566). Bivariate correlation and multivariable regression analysis of the SrO2 change score further demonstrated no statistically significant correlation between percent of CBV removed during RAP/VAP or ANH and the magnitude of the decline in SrO2. RAP and VAP help minimize hemodilution at the onset of CPB. This study further supports the use of these techniques in a pediatric population by demonstrating declines in SrO2 during RAP/VAP were consistent among cyanotic and acyanotic, including those who underwent ANH.