Impact of Fluid Restriction Policy in Reducing the Use of Red Cells in Cardiac Surgery

Impact of Fluid Restriction Policy Added to Intra-Operative Cell Salvage in Reducing the Use of Red Cells in Cardiac Surgery

The investigators' hypothesis is that restriction of circulating fluids in comparison to a liberal fluid administration policy would lead to a reduction of allogenic red blood cells exposure in patients undergoing cardiopulmonary bypass (CPB) for primary coronary artery bypass graft supported by reinfusion of washed shed blood from thoracic cavities.

192 patients operated under equal conditions were assigned prospectively and randomly either for a restrictive protocol for intravenous fluid administration (group A, 100 patients) or not (group B, 92 patients). Transfusion guidelines were common for the two groups. The volumes of intravenous fluids, priming, "extra" volume on pump and cardioplegic solution and the volume of urine were recorded. Net erythrocyte volume loss was calculated. The number of the transfused PRC was analyzed as a continuous variable. "Transfusion" was analyzed as a categorical characteristic. Analysis employed Student's two-tailed t-test, t-paired test and chitest.

Inclusion Criteria:

• Ejection fraction (EF) of left ventricle (LV) > 35%
• Preoperative serum Creatinine < 150 μmol/l
• Preoperative Haemoglobin > 10/dl
• Peripheral anastomosis scheduled =< 3

Exclusion Criteria:

• redo bypass-emergency operations
• prior coronal stenting
• active congestive heart failure
• documented Myocardial Infraction within the previous 6 weeks
• NYHA class > 3
• Carotid stenosis > 50%
• CVA
• INR > 1.5
• chronic obstructive pulmonary disease (COPD)
• Steroid therapy-chronic inflammatory process
• Use of aprotinin or tranexamic acid