The tactics for finishing the artificial circulation procedure within the framework of blood-saving concept for cardiosurgical operations

BACKGROUND: Cardiosurgical interventions in the settings of artificial circulation are usually characterized by the significant blood loss and by the need for transfusing donor blood components. Besides the systemic inflammatory reaction, hemodilution and hypocoagulation, an important contribution into the development of perioperative anemia is added by the blood loss associated with the finishing stage of the artificial circulation. AIM: An optimization of the finishing stage of artificial circulation for decreasing the blood loss during the heart surgeries. METHODS: The patients operated in the settings of artificial circulation (n=62) were randomized into two groups. In the main group (n=31) upon the end of the artificial circulation, the whole blood volume in all the tubes of the artificial circulation equipment was returned to the central vein of the patient. In the comparison group (n=31), the method used was the return of residual blood from the pipelines of the artificial circulation equipment by means of substitution with physiological saline. The analysis included the data obtained using the laboratory and instrumental methods of examination. RESULTS: The intraoperative blood loss in the main group was significantly lower comparing to the one in the comparison group (500 ml [470–520] versus 800 ml [760–830], р=0.0001). In 24 hours after surgery, the levels of creatinine, alanine aminotransferase and amylase were higher in the main group than in the comparison group. At the end of surgery, the main group also had higher values of the cardiac output (3.1 [2.8–3.6] versus 2.8 [2.6–3.1], р=0.018) and the global ejection fraction (28 [22–31] versus 22 [19–24], р=0.011). In the comparison group, the global end-diastolic volume index has significantly decreased comparing to the initial level (753 [665–900] and 647 [615–820] respectively, р=0.019). No adverse events or reactions were registered during the research. CONCLUSION: The complete return of blood after the artificial circulation into the organism of the patient results in an increase in the levels of hemoglobin and hematocrit at the early post-surgery period, and it is accompanied by lesser volume of blood loss and higher levels of the cardiac index and the global ejection fraction after the main surgery phase with a background of the absence of significant adverse events.