Low-prime perfusion circuit and autologous priming in CABG surgery on a Jehova’s Witness: a case report

• Published in: Perfusion 2002-01, Vol.17 (1), p.69-72
• Main Authors: van Kempen, R A Brest, Gasiorek, J M, Bloemendaal, K, van Leeuwen, R PH Storm, Bulder, E R
• Format: Article
• Language: English
• ISSN: 0267-6591; 1477-111X
• DOI: 10.1191/0267659102pf522cr

Cardiac surgery on Jehovah’s Witnesses is a great challenge for the cardiothoracic surgery team and especially for the perfusionist. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A small bypass system was built, consisting of a 3/8-in. arterial line and a 3/8-in. venous line, a venous collapsible reservoir, a centrifugal pump, a hollow fiber oxygenator and a cell saver reservoir. The circuit priming volume was 650 ml. By using antegrade and retrograde autologous priming, the total amount of priming was reduced to ± 50 ml. Bypass time was 63 min with an average blood flow of 5300± 114 ml/min and postmembrane pressures of 180± 45 mmHg. Venous line pressure was monitored and kept between -8 and -20 mmHg with a mean arterial pressure (MAP) of 55± 12.3 mmHg. The hematocrit before extracorporeal circulation (ECC) was 36%, per-ECC 35% and post-ECC 35%. On the fifth postoperative day, the hematocrit was 40%. The patient was discharged 7 days after surgery. A low-prime circuit, in combination with autologous priming, seems to be safe and effective in avoiding the use of banked blood.