EVENT ABSTRACTS
Objective
Priming of the heart lung machine in cardiopulmonary bypass (CPB) consists of crystalloid and colloid fluids. Sometimes red blood cells (RBC) are added to avoid an unacceptable level of haemodilution. Increased morbidity and mortality is a known complication of RBC transfusion. Asanguinous priming is not common practice in paediatric patients under 10kg, however existing studies demonstrate that it can be done safely using a miniaturised circuit. This study aims to assess the safety and efficacy of asanguinous priming in patients 5-10kg, in a standard neonatal circuit.
Methods
218 patients undergoing CPB for congenital heart surgery at a single centre between 2018-2023, who either received blood or asanguinous (clear) prime. Baseline characteristics were collected, and various outcomes were compared across prime groups.
Results
Predictors of being given a clear prime were weight (OR 1.87, 1.334,2.620), baseline haemoglobin (OR 1.077, 1.048-1.106) and CPB time (0.988, 0.976-0.999).
Descriptive statistics demonstrated that AKI stage, peak lactate levels, length of hospital stay and 30-day mortality outcomes were similar across both prime groups.
Using a multivariate linear regression clear prime was associated with a 14g/L decrease in post operative haemoglobin. A multivariate linear regression for transfusion intraoperatively (mls/kg) was significant at predicting 45% of variance. Higher quantities of intraoperative RBC transfusion occurred in females (p0.023), longer CPB time (p<0.001), lower baseline haemoglobin (p<0.001) and being younger in age (p<0.001). Patients in the clear prime group received 11mls/kg less than those in blood prime intraoperatively. Prime group did not influence the volume of post operative transfusion and was only predicted by CPB and cross clamp time (p<0.001).
Conclusion
Outcomes of patients who received asanguinous prime were noninferior to those who had a blood prime. Patients who received asanguinous prime were heavier, older and had a higher baseline haemoglobin.
My name is Becky Gendall, I work at the Royal Brompton Hospital where I completed my two years of training. Prior to this I worked as a paediatric nurse for 5 years firstly on a cardiac ward at the Evelina and the CICU at Great Ormond Street. Outside of work I enjoy figure skating, I represented GB in an international competition earlier this year.
