A Sahlman1, J Ahonen, J A Salo, O J Rämö. 1. Department of Cardiothoracic Surgery, Helsinki University Hospital, FIN-00020 HUS, Helsinki, Finland.
Abstract
BACKGROUND: Contact of blood with foreign surfaces in the cardiopulmonary bypass (CPB) circuit induces an inflammatory response and immunosuppression which are associated with several organ dysfunctions following cardiac surgery. The aim of the present study was to evaluate clinical patient recovery after coronary artery bypass surgery (CABG) using CPB with leucocyte filtration or no arterial line filter. METHODS:Sixty patients scheduled for CABG were randomly assigned to undergo CPB with a leucocyte depleting arterial line filter (Pall LG6) or no filter. Total leucocyte count and platelet count were determined before and after CPB. Values for blood urea nitrogen, serum creatine, serum sodium and potassium, serum osmolality, urine creatine, urine sodium and potassium, and urine osmolality were recorded at baseline, at 6 h and 24 h after CPB, and on the 5th postoperative day. Complement status was evaluated by measuring the levels of C3 and C4 before surgery and 24 h after CPB. Need for postoperative inotropic support was recorded, as was oxygen index prior to and after tracheal extubation. Times to awakening and tracheal extubation were noted, as were length of stay at the intensive care unit (ICU) and the hospital. Amount of chest drainage until 24 h and need for red blood cell transfusions were recorded. RESULTS: The level of C3 at 24 h was significantly lower in LG6-patients, but no further differences were detected between the groups in any of the laboratory or clinical parameters except for greater chest drainage in LG6-patients. However, need for red blood cell transfusions was similar in both groups. CONCLUSION:Leucocyte filtration in our elective CABG patients did not have any impact on pulmonary gas exchange, need for postoperative inotropic support, length of postoperative mechanical ventilation, or length of ICU or hospital stay.
RCT Entities:
BACKGROUND: Contact of blood with foreign surfaces in the cardiopulmonary bypass (CPB) circuit induces an inflammatory response and immunosuppression which are associated with several organ dysfunctions following cardiac surgery. The aim of the present study was to evaluate clinical patient recovery after coronary artery bypass surgery (CABG) using CPB with leucocyte filtration or no arterial line filter. METHODS: Sixty patients scheduled for CABG were randomly assigned to undergo CPB with a leucocyte depleting arterial line filter (Pall LG6) or no filter. Total leucocyte count and platelet count were determined before and after CPB. Values for blood ureanitrogen, serum creatine, serum sodium and potassium, serum osmolality, urine creatine, urine sodium and potassium, and urine osmolality were recorded at baseline, at 6 h and 24 h after CPB, and on the 5th postoperative day. Complement status was evaluated by measuring the levels of C3 and C4 before surgery and 24 h after CPB. Need for postoperative inotropic support was recorded, as was oxygen index prior to and after tracheal extubation. Times to awakening and tracheal extubation were noted, as were length of stay at the intensive care unit (ICU) and the hospital. Amount of chest drainage until 24 h and need for red blood cell transfusions were recorded. RESULTS: The level of C3 at 24 h was significantly lower in LG6-patients, but no further differences were detected between the groups in any of the laboratory or clinical parameters except for greater chest drainage in LG6-patients. However, need for red blood cell transfusions was similar in both groups. CONCLUSION: Leucocyte filtration in our elective CABG patients did not have any impact on pulmonary gas exchange, need for postoperative inotropic support, length of postoperative mechanical ventilation, or length of ICU or hospital stay.