*Clinical Perfusionist, Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi
**Senior Perfusionist, Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi
***Professor, Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi
****Professor & Head, Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi
*****Professor, Department of Cardio-Thoracic and Vascular Anaesthesia, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi
Cardiopulmonary bypass (CPB) is associated with a “whole body inflammatory response” characterized by capillary leak and increased total body water (1). The development of tissue edema may cause dysfunction of vital organ systems leading to significant morbidity and mortality (2,3).
This prospective, randomized study was designed to investigate the effects of conventional ultrafiltration in paediatric patients undergoing corrective surgery for congenital heart disease using CPB.
One fifty children aged between 2–14 years with Tetralogy of Fallot (TOF) undergoing intra cardiac repair on CPB were divided into two groups. Group-I comprised of 75 children in whom conventional ultrafiltration (CUF) was performed intraoperatively and during rewarming period of cardiopulmonary bypass. Group-II comprised of 75 children in whom no ultrafiltration was performed.
Intraoperative urine production, fluid overload (net pump balance after CPB), electrolyte disbalance, and postoperative chest tube drainage, ventilation time, blood and blood component transfusion requirement from the end of bypass procedure until 24 hours in intensive care unit were studied in both groups.
Results were analysed by students paired ‘t’ test, Mann- Whitney test and Wilcoxon Signed Ranks.
To maintain haematocrit level 30% during CPB, in group-I (n=74) conventional ultrafiltration was performed and in group-II (n=73) packed red blood cells were added.
In group-I: Urine output (159.77ml ± 69.3ml) during CPB was not significantly different from group-II where urine output was (243.2ml ± 85ml). The mean total haemofiltrate (444.19 ml ± 169.17 ml) volume were removed only in group-I during intraoperative period of cardiopulmonary bypass.
There were significant (p<0.05) difference in haematocrit 39.03% ± 11.1% in group-I versus 29.04% ± 7.1% in group-II on arrival in the intensive care, ventilation time 593.8 minute in group-I and 802.2 in group-II, chest tube drainage was 41.6ml±12.1ml in group-I versus 136.80ml±41.1ml in group-II at 24 hours postoperatively. Body temperature was significantly lower (p<0.05) at 24 hours (35°C) in group-I as compared to group-II where body temperature was 38°C. There were no significant (p>0.05) difference found in electrolytes level in both groups intraoperatively and postoperatively.
We conclude from our study that the use of conventional ultrafiltration can effectively concentrate blood, reduce postoperative ventilation time and decrease postoperative blood transfusion requirements in children undergoing corrective surgery on cardiopulmonary bypass It was concluded that routine use of ultrafiltration is beneficial for paediatric patients.
Cardiopulmonary bypass, convenventional ultrafiltration, postoperative blood loss and blood transfusion requirements, ventilation time
