Ringer-lactate solution as a priming fluid for the disc oxygenator.

Gadboys, Slonim, and Litwak (1962) reported what is now known as the homologous blood syndrome, which stimulated work on a substitute for blood in open-heart surgery, especially for the priming of the heart-lung machine. The homologous blood syndrome was noted in experimental animals and consisted of hypotension on commencing cardiopulmonary bypass, with early thrombocytopenia, leucopenia, sequestration of blood elements, and subsequent pulmonary and renal problems. Gadboys et al. concluded that the changes were consistent with antigen-antibody reactions other than those due to ABO and Rh incompatibilities. An obvious substitute was a colloid, such as a low molecular weight dextran (rheomacrodex) (Long, Sanchez, Varco, and Lillehei, 1961; Raison, 1962). Others have described using electrolyte solutions as partial primes and also as total non-blood primes. Neptune, Bougas, and Panico (1961) reported the use of physiological saline; Zuhdi, McColloughl, Carey, and Greer (1961), Cooley, Beall, and Grondin (1962), and Zuhdi, Carey, Sheldon, and Greer (1964) used 5% dextrose in water, but as this was physiologically hypotonic, Linder, Sakai, and Paton (1964) attempted to improve the solution by using varying concentrations of saline rather than water. They found that 5% dextrose in 0O22% saline gave the best results. Neville, Faber, and Peacock (1964a) showed that Ringer-lactate solution (Hartmann's solution) caused minimal disturbances of acid/base and electrolyte homoeostasis and seemed to be the most physiologically acceptable priming fluid available. Total non-blood priming has required heartlung machines with reasonably small priming volumes, and this has discouraged the use of this