Association of plasma dilution with cardiopulmonary bypass-associated bleeding and morbidity

Stanley D. Brauer, Richard Lee Applegate, Jessie J. Jameson, Karen L. Hay, Ryan E. Lauer, Paul C. Herrmann, Brian S. Bull

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To investigate the relationship of cardiopulmonary bypass-associated plasma dilution with blood product transfusion and postoperative morbidity. Design: Retrospective chart review. Setting: Single academic medical center. Participants: Five hundred forty adults undergoing cardiac surgery between January 4, 2005 and September 19, 2007. Interventions: Records were analyzed for demographics, blood volumes (BVs), and fluid balance. Plasma protein concentrations (% of baseline) at the end of bypass were calculated. The lowest and highest quartiles of plasma protein concentration were correlated with blood product administration and postoperative complications. Measurements and Main Results: At the end of bypass, calculated plasma protein concentrations ranged from a low of 10% to a high of 111% of baseline. Concentrations below 45% of baseline were associated with increased blood product administration, longer ventilator support, and longer intensive care unit stay. Conclusions: Patient morbidity and likelihood of transfusion were associated with calculated plasma protein concentrations below 45% of baseline. Bleeding and administered fluids decrease both hematocrit and plasma proteins. Infusion of washed, salvaged blood or red blood cells raises hematocrit, but further dilutes clotting factors. If this dilution is excessive, coagulopathy may ensue. Patients with the smallest BVs are at greatest risk, but dilution can negatively impact patients with large BVs as well if the fluid used for cardiopulmonary bypass prime and anesthesia management represents a significant fraction of total BV.

Original languageEnglish (US)
Pages (from-to)845-852
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume27
Issue number5
DOIs
StatePublished - Oct 2013
Externally publishedYes

Fingerprint

Cardiopulmonary Bypass
Blood Proteins
Blood Volume
Hemorrhage
Morbidity
Hematocrit
Water-Electrolyte Balance
Blood Coagulation Factors
Mechanical Ventilators
Blood Transfusion
Thoracic Surgery
Intensive Care Units
Anesthesia
Erythrocytes
Demography

Keywords

  • blood transfusion
  • blood, blood coagulation factors
  • Cardiac surgical procedures
  • cardiopulmonary bypass
  • postoperative complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Association of plasma dilution with cardiopulmonary bypass-associated bleeding and morbidity. / Brauer, Stanley D.; Applegate, Richard Lee; Jameson, Jessie J.; Hay, Karen L.; Lauer, Ryan E.; Herrmann, Paul C.; Bull, Brian S.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 27, No. 5, 10.2013, p. 845-852.

Research output: Contribution to journalArticle

Brauer, Stanley D. ; Applegate, Richard Lee ; Jameson, Jessie J. ; Hay, Karen L. ; Lauer, Ryan E. ; Herrmann, Paul C. ; Bull, Brian S. / Association of plasma dilution with cardiopulmonary bypass-associated bleeding and morbidity. In: Journal of Cardiothoracic and Vascular Anesthesia. 2013 ; Vol. 27, No. 5. pp. 845-852.
@article{5948f7e485e44dd886229b4ca10c9b56,
title = "Association of plasma dilution with cardiopulmonary bypass-associated bleeding and morbidity",
abstract = "Objective: To investigate the relationship of cardiopulmonary bypass-associated plasma dilution with blood product transfusion and postoperative morbidity. Design: Retrospective chart review. Setting: Single academic medical center. Participants: Five hundred forty adults undergoing cardiac surgery between January 4, 2005 and September 19, 2007. Interventions: Records were analyzed for demographics, blood volumes (BVs), and fluid balance. Plasma protein concentrations ({\%} of baseline) at the end of bypass were calculated. The lowest and highest quartiles of plasma protein concentration were correlated with blood product administration and postoperative complications. Measurements and Main Results: At the end of bypass, calculated plasma protein concentrations ranged from a low of 10{\%} to a high of 111{\%} of baseline. Concentrations below 45{\%} of baseline were associated with increased blood product administration, longer ventilator support, and longer intensive care unit stay. Conclusions: Patient morbidity and likelihood of transfusion were associated with calculated plasma protein concentrations below 45{\%} of baseline. Bleeding and administered fluids decrease both hematocrit and plasma proteins. Infusion of washed, salvaged blood or red blood cells raises hematocrit, but further dilutes clotting factors. If this dilution is excessive, coagulopathy may ensue. Patients with the smallest BVs are at greatest risk, but dilution can negatively impact patients with large BVs as well if the fluid used for cardiopulmonary bypass prime and anesthesia management represents a significant fraction of total BV.",
keywords = "blood transfusion, blood, blood coagulation factors, Cardiac surgical procedures, cardiopulmonary bypass, postoperative complications",
author = "Brauer, {Stanley D.} and Applegate, {Richard Lee} and Jameson, {Jessie J.} and Hay, {Karen L.} and Lauer, {Ryan E.} and Herrmann, {Paul C.} and Bull, {Brian S.}",
year = "2013",
month = "10",
doi = "10.1053/j.jvca.2013.01.011",
language = "English (US)",
volume = "27",
pages = "845--852",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Association of plasma dilution with cardiopulmonary bypass-associated bleeding and morbidity

AU - Brauer, Stanley D.

AU - Applegate, Richard Lee

AU - Jameson, Jessie J.

AU - Hay, Karen L.

AU - Lauer, Ryan E.

AU - Herrmann, Paul C.

AU - Bull, Brian S.

PY - 2013/10

Y1 - 2013/10

N2 - Objective: To investigate the relationship of cardiopulmonary bypass-associated plasma dilution with blood product transfusion and postoperative morbidity. Design: Retrospective chart review. Setting: Single academic medical center. Participants: Five hundred forty adults undergoing cardiac surgery between January 4, 2005 and September 19, 2007. Interventions: Records were analyzed for demographics, blood volumes (BVs), and fluid balance. Plasma protein concentrations (% of baseline) at the end of bypass were calculated. The lowest and highest quartiles of plasma protein concentration were correlated with blood product administration and postoperative complications. Measurements and Main Results: At the end of bypass, calculated plasma protein concentrations ranged from a low of 10% to a high of 111% of baseline. Concentrations below 45% of baseline were associated with increased blood product administration, longer ventilator support, and longer intensive care unit stay. Conclusions: Patient morbidity and likelihood of transfusion were associated with calculated plasma protein concentrations below 45% of baseline. Bleeding and administered fluids decrease both hematocrit and plasma proteins. Infusion of washed, salvaged blood or red blood cells raises hematocrit, but further dilutes clotting factors. If this dilution is excessive, coagulopathy may ensue. Patients with the smallest BVs are at greatest risk, but dilution can negatively impact patients with large BVs as well if the fluid used for cardiopulmonary bypass prime and anesthesia management represents a significant fraction of total BV.

AB - Objective: To investigate the relationship of cardiopulmonary bypass-associated plasma dilution with blood product transfusion and postoperative morbidity. Design: Retrospective chart review. Setting: Single academic medical center. Participants: Five hundred forty adults undergoing cardiac surgery between January 4, 2005 and September 19, 2007. Interventions: Records were analyzed for demographics, blood volumes (BVs), and fluid balance. Plasma protein concentrations (% of baseline) at the end of bypass were calculated. The lowest and highest quartiles of plasma protein concentration were correlated with blood product administration and postoperative complications. Measurements and Main Results: At the end of bypass, calculated plasma protein concentrations ranged from a low of 10% to a high of 111% of baseline. Concentrations below 45% of baseline were associated with increased blood product administration, longer ventilator support, and longer intensive care unit stay. Conclusions: Patient morbidity and likelihood of transfusion were associated with calculated plasma protein concentrations below 45% of baseline. Bleeding and administered fluids decrease both hematocrit and plasma proteins. Infusion of washed, salvaged blood or red blood cells raises hematocrit, but further dilutes clotting factors. If this dilution is excessive, coagulopathy may ensue. Patients with the smallest BVs are at greatest risk, but dilution can negatively impact patients with large BVs as well if the fluid used for cardiopulmonary bypass prime and anesthesia management represents a significant fraction of total BV.

KW - blood transfusion

KW - blood, blood coagulation factors

KW - Cardiac surgical procedures

KW - cardiopulmonary bypass

KW - postoperative complications

UR - http://www.scopus.com/inward/record.url?scp=84884533372&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884533372&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2013.01.011

DO - 10.1053/j.jvca.2013.01.011

M3 - Article

C2 - 23791494

AN - SCOPUS:84884533372

VL - 27

SP - 845

EP - 852

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 5

ER -