Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis

Objective: Reducing the priming volume is an effective means of decreasing hemodilution and blood transfusion during cardiopulmonary bypass (CPB). The patient’s own blood was used to replace the crystalloid in the CPB circuit by retrograde autologous priming (RAP) in order to decrease the priming volume. Therefore, we performed a meta-analysis to investigate whether RAP could reduce blood transfusion and improve clinical outcomes. Materials and Methods: A comprehensive search was conducted for randomized, controlled trials (RCTs) exploring RAP in PubMed, Embase, The Cochrane Library, Google Scholar and Chinese literature databases (WanFang, WeiPu and CNKI). Clinical parameters and outcomes were focused on the lowest hematocrit (Hct) during CPB, the number of patients transfused blood intraoperatively, the number of patients transfused blood perioperatively, the number of blood units transfused, 24-hour chest tube drainage, hours to extubation, length of ICU stay, and length of hospital stay. Results: Ten trials, with a total of 1123 patients, were included. The number of patients transfused blood intraoperatively (RR = 0.39, 95% CI = [0.29, 0.53], p<0.00001, I2 = 40%) and perioperatively (RR = 0.53, 95% CI = [0.43, 0.66], p<0.00001, I2 = 0%) and the number of blood units transfused (SMD = -0.53, 95% CI = [-0.73, -0.33], p<0.00001, I2 = 14%) were all significantly reduced in the RAP group. No differences in the hours to extubation (SMD = -0.11, 95% CI = [-0.33, 0.12], p=0.37, I2 = 0%) and the length of ICU stay (SMD = -0.17, 95% CI = [-0.41, 0.08], p=0.18, I2 = 0%) were observed between the two groups. Conclusion: Compared to conventional priming, RAP could reduce transfusion in adults significantly, but had no effect on clinical outcomes, comparing to conventional priming. Further studies involving RAP are expected to investigate if this technique is beneficial to the patient.

[1]  L. Xiaofeng.  Application of retrograde autologous priming in cardiopulmonary bypass of infants , 2013 .

[2]  P. Evora,et al.  Retrograde autologous priming in cardiopulmonary bypass in adult patients: effects on blood transfusion and hemodilution. , 2011, Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular.

[3]  Jeffrey Hammond,et al.  Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients , 2011, BMC health services research.

[4]  Howard K. Song,et al.  2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. , 2011, The Annals of thoracic surgery.

[5]  R. Kind,et al.  On-pump aortic valve replacement without allogeneic blood product transfusion , 2011 .

[6]  Howard K. Song,et al.  Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines , 2011 .

[7]  E. Schmid,et al.  On-pump coronary artery bypass surgery without allogenic blood product transfusion , 2010 .

[8]  Yanyan Zhao,et al.  Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion in small adults: a prospective, randomized trial , 2009, European journal of anaesthesiology.

[9]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[10]  C. Tchervenkov,et al.  Retrograde autologous priming and allogeneic blood transfusions: a meta-analysis. , 2009, Interactive cardiovascular and thoracic surgery.

[11]  Bradley T. Kulat,et al.  Optimizing circuit design using a remote-mounted perfusion system. , 2009, The journal of extra-corporeal technology.

[12]  Y. Durandy.  The Impact of Vacuum-Assisted Venous Drainage and Miniaturized Bypass Circuits on Blood Transfusion in Pediatric Cardiac Surgery , 2009, ASAIO journal.

[13]  G. Gravlee.  Duration of Red-Cell Storage and Complications after Cardiac Surgery , 2009 .

[14]  A. Zangrillo,et al.  Reduction of hemodilution in small adults undergoing open heart surgery: a prospective, randomized trial , 2007, Perfusion.

[15]  M. Slaughter,et al.  Prospective study on cardiopulmonary bypass prime reduction and its effect on intraoperative blood product and hemoconcentrator use , 2005, Perfusion.

[16]  S. W. Sutton,et al.  Leukocyte filtration and miniature perfusion during arrested heart CABG on a Jehovah’s Witness patient , 2004, Perfusion.

[17]  J. McDonald,et al.  Retrograde autologous prime with shortened bypass circuits decreases blood transfusion in high-risk coronary artery surgery patients. , 2004, The journal of extra-corporeal technology.

[18]  J. Vender,et al.  The Failure of Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit to Reduce Blood Use After Cardiac Surgical Procedures , 2004, Anesthesia and analgesia.

[19]  R. Lange,et al.  Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery? , 2003, The Annals of thoracic surgery.

[20]  A. Jain,et al.  Intraoperative autologous blood donation and retrograde autologous priming for cardiopulmonary bypass: a safe and effective technique for blood conservation. , 2003, Annals of Cardiac Anaesthesia.

[21]  R. Habib,et al.  Effect of blood transfusion on long-term survival after cardiac operation. , 2002, The Annals of thoracic surgery.

[22]  S. Karthikeyan,et al.  Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion after coronary artery surgery. , 2002, The Annals of thoracic surgery.

[23]  E. Bulder,et al.  Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehova’s Witness: a case report , 2002, Perfusion.

[24]  K. Srinivas,et al.  Combination of autologous Transfusion and Retrograde Autologous Priming Decreases Blood Requirements. , 2001, Annals of Cardiac Anaesthesia.

[25]  R. Engelman,et al.  The ‘Primeless Pump’: A Novel Technique for Intraoperative Blood Conservation , 1999 .

[26]  R. Shemin,et al.  Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime volume. , 1998, The Annals of thoracic surgery.

[27]  G. Hartman,et al.  Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements. , 1998, The Journal of thoracic and cardiovascular surgery.

[28]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.