The Effect of Zero Balance Ultrafiltration of Priming Blood on Clinical Outcomes of Infants Undergo Cardiopulmonary Bypass

Introduction: Pediatric Cardiopulmonary Bypass (CPB) circuit invariably requires priming with Packed Red Blood Cells (PRBCs). Metabolic composition of stored PRBCs is unphysiological. Commencement of PRBC primed CPB leads to rapid transfusion of massive metabolic load. This predisposes pediatric patients to the risk of complications such as electrolyte disturbances, citrate toxicity, acidosis and activation of the inflammatory response. The aim of this study is to evaluate the effect of ultrafiltration of priming blood on clinical outcomes infants undergo cardiopulmonary bypass.  Methods: This was a clinical trial, with two groups (intervention and control) and a sample of 60 infants referred to Shahid Rajaie Hospital in Tehran (30 patients in intervention and 30 patients in control group) that was carried out in 2017. Ultrafiltration was used on prime with Conventional Ultrafiltration (CUF) for patients in the intervention group during CPB, but in the control group only CUF was used. Arterial blood gas parameters, amount of bleeding, blood transfusion rate, the duration of mechanical ventilation, residence in the ICU and the level of electrolytes were measured. Data of this study was analyzed using the Chi-square test, T- test Independent-Sample, Repeated-measure, Mann Whitney U test by SPSS 25. Results: In terms of electrolytes, the prime solution used in the intervention group was significantly closer to physiological comparing to the control group (P<0.05). The intervention group showed significant reductions in postoperative blood loss; postoperative blood transfusion; time to extubation; the length of stay in the ICU; (P<0.05). The level of electrolytes and other parameters of arterial blood gas were similar in both groups. Conclusions: It can be concluded that the combination of the ultrafiltration of priming blood and CUF method effectively reduces the side effects of cardiopulmonary bypass.