The tactics of weaning from cardiopulmonary bypass with blood-saving technique in cardiac surgery

BACKGROUND: Cardiac surgery under cardiopulmonary bypass is typically characterized by significant blood loss and the need for donor red blood cell transfusions. In addition to the inflammatory response, hemodilution, hypocoagulation, and blood loss significantly contributes to the development of perioperative anemia associated with the weaning from the cardiopulmonary bypass. AIM: Optimization of weaning from cardiopulmonary bypass to reduce blood loss during cardiac surgery. METHODS: Patients undergoing cardiac surgery under cardiopulmonary bypass (n=62) were divided into two groups. In the study group (n=31), all blood from cardiopulmonary bypass circuit was returned to the patient's central vein at the end of the cardiopulmonary bypass. In the comparison group (n=31), a standard method of pushing a residual blood volume from the cardiopulmonary bypass circuit with normal saline was used. Laboratory and instrumental data were analyzed. RESULTS: Intraoperative blood loss in the study group was significantly lower than in the comparison group (500 [470–520] ml versus 800 [760–830] ml, p=0.0001). Twenty-four hours after surgery, creatinine, alanine aminotransferase, and amylase concentrations were higher in the study group than in the comparison group. At the end of surgery, the study group also had higher cardiac index (3.1 [2.8–3.6] versus 2.8 [2.6–3.1] l/m2 per minute, p=0.018) and global ejection fraction (28 [22–31] versus 22 [19–24]%], p=0.011). No adverse events or reactions were registered during the study. CONCLUSION: Complete blood return after cardiopulmonary bypass results in higher hemoglobin and hematocrit levels in the early postoperative period, accompanied by less blood loss and higher cardiac index and global ejection fraction after the main stage of the surgery without significant adverse events.