The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass

Linda B. Mongero, Eric A. Tesdahl, Alfred Stammers, Samuel Weinstein

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Ultrafiltration during cardiopulmonary bypass (CPB) reduces fluid overload and inflammatory mediators in open-heart surgery and is thought to reduce the risk of red blood cell (RBC) transfusion. We evaluated its effectiveness in reducing RBC transfusions in a large population undergoing cardiac surgery, among patients in general as well as by gender. Methods: We analyzed 40,650 propensity-matched adult cardiac surgery cases conducted over a 61-month period at 195 hospitals. We assessed the risk of intraoperative transfusion (⩾1 unit RBC) according to body surface area (BSA)-normalized ultrafiltration volume via mixed-effects binary logistic regression. Our statistical model controlled for 12 demographic and operative variables as well as for center level tendencies in ultrafiltration use and intraoperative RBC transfusion. In light of recent findings on gender and risk of transfusion, we also included an interaction effect between gender and ultrafiltration volume (UV). Results: Ultrafiltration was associated with an increased crude rate of RBC transfusion (32.1% vs. 28.1%, p<0.001), but equivalent crude median hematocrit change from first in operating room to nadir on bypass (−11% in both groups, p = 0.133). After controlling for patient, operative and site-level characteristics, we found no statistically significant effect on transfusion rate by volume of ultrafiltrate removed nor did we find statistical support for any gender-specific effect of ultrafiltration. Conclusions: Ultrafiltration is not associated with a reduction of risk of RBC transfusion during cardiac surgery. The use of ultrafiltration as a method for reducing intraoperative RBC transfusion warrants further study.

Original languageEnglish (US)
JournalPerfusion (United Kingdom)
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Erythrocyte Transfusion
Ultrafiltration
Cardiopulmonary Bypass
surgery
Blood
Cells
gender
Surgery
Thoracic Surgery
logistics
Operating rooms
regression
Body Surface Area
Statistical Models
Operating Rooms
Risk Reduction Behavior
interaction
Hematocrit
Logistics
Group

Keywords

  • blood management
  • cardiopulmonary bypass
  • gender
  • propensity
  • ultrafiltration

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass. / Mongero, Linda B.; Tesdahl, Eric A.; Stammers, Alfred; Weinstein, Samuel.

In: Perfusion (United Kingdom), 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Ultrafiltration during cardiopulmonary bypass (CPB) reduces fluid overload and inflammatory mediators in open-heart surgery and is thought to reduce the risk of red blood cell (RBC) transfusion. We evaluated its effectiveness in reducing RBC transfusions in a large population undergoing cardiac surgery, among patients in general as well as by gender. Methods: We analyzed 40,650 propensity-matched adult cardiac surgery cases conducted over a 61-month period at 195 hospitals. We assessed the risk of intraoperative transfusion (⩾1 unit RBC) according to body surface area (BSA)-normalized ultrafiltration volume via mixed-effects binary logistic regression. Our statistical model controlled for 12 demographic and operative variables as well as for center level tendencies in ultrafiltration use and intraoperative RBC transfusion. In light of recent findings on gender and risk of transfusion, we also included an interaction effect between gender and ultrafiltration volume (UV). Results: Ultrafiltration was associated with an increased crude rate of RBC transfusion (32.1{\%} vs. 28.1{\%}, p<0.001), but equivalent crude median hematocrit change from first in operating room to nadir on bypass (−11{\%} in both groups, p = 0.133). After controlling for patient, operative and site-level characteristics, we found no statistically significant effect on transfusion rate by volume of ultrafiltrate removed nor did we find statistical support for any gender-specific effect of ultrafiltration. Conclusions: Ultrafiltration is not associated with a reduction of risk of RBC transfusion during cardiac surgery. The use of ultrafiltration as a method for reducing intraoperative RBC transfusion warrants further study.",
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