Evaluation of the effects of changes in cardiopulmonary bypass prime volume on intraoperative/postoperative blood use and systemic inflammation

Cardiopulmonary bypass is a technique which cardiac and pulmonary functions transferred temporarily to the extracorporeal pump and oxygenator system in order to maintain blood and oxygene supply to the body. Inflamattory response and hemodilutional anemia resulting from prime volume overload, lead to the intraopreative and postoperative blood transfusions and this situation open the gates for the increased transfusion rates and inflammatory complications related to transfusions. The aim of this study is evaluate the relationship between the reduction of the cardiopulmonary bypass prime volume and transfusion rates, the inflammation that creates a systematic response that requires cultore examination or a modification of antibiotherapy and the cost burden of this situation. A total of 452 patients who underwent elective coronary artery bypass grafting operation at Dokuz Eylul University Medical Faculty Hospital over a five-year period were included in the study. The prime volume index was obtained by dividing the cardiopulmonary bypass prime volume values of the patients by the body surface areas. The study group was divided into two as high prime volume index and low prime volume index according to the median value. Data were evaluated by dividing demographic parameters, intraoperative parameters, hemodilution-related parameters, inflammation-related parameters, and cost values. The prime volume index was higher in patients with low body surface area and it was observed that these patients were more anemic in all hematocrit measurements made since the beginning of cardiopulmonary bypass. Intraoperative and postoperative blood transfusion rates were found to be significantly higher in patients in the high pvi group. It was observed that the reflection of the inflammatory response on the clinical picture was significantly stronger in the patients in the high pvi group. It was observed that the rates of culture tests that did not show the presence of infection and the rates of antibiotic therapy not supported by culture positivity were significantly higher in these patients. It was observed that by reducing the prime volume as much as possible, a reduction in the total treatment costs of the patients could be achieved. Although hemodilutional anemia is almost the gold standard for cardiopulmonary bypass practice, it is a subject that needs to be handled very carefully due to its positive and negative effects. It is recommended to use cardiopulmonary bypass priming volume as low as possible to avoid transfusions and related complications. Since there is no clear consensus on the superiority of the prime volume-reducing techniques over each other, it is recommended to try to reduce the blood's foreign-surface contact and fluid overload in every possible way. Considering the situation of the health economy in our country, it is vital to reduce the cost of surgical treatments.