Table 3.
Protocols
1). Protocol for blood conservation |
a) Preoperative |
EPO if hemoglobin levels are <14 g/l | |
Iron in all cases | |
Limit the removal of blood in frequency and quantity (use pediatric tubes) | |
Aprotinin (Hammersmith half-protocol) | |
Avoid hematomas following angiography and PCI. | |
b) Perioperative | |
Retropriming | |
Short CPB circuit. Heparinization 3 mg/kg body weight reversed by equivalent dose of protamine IV | |
CPB conducted in normothermia (minimal temperature drift 36 °C) | |
Warm cardioplegia | |
Cell Saver | |
Minimally invasive surgical techniques | |
Meticulous closure | |
c) Post operative | |
Reduce blood retrieval in frequency and quantity (use pediatric tubes) | |
Reoperate if blood loss continues at 100 cc for three hrs, or immediately if > 200 cc in one hour. | |
EPO if hematocrit < 24% at time of reoperation | |
2). Protocol of Aprotonin Administration (Hammersmith Half-Protocol) until its withdrawal in 2007 , then aminocaproic acid is used in all cases |
1 million KIU (140 mg) IV at induction of anesthesia, 1 million KIU (140 mg) at completion of CPB and 250,000 KIU (35 mg) IV per hour until skin closure or until a maximum dose of 1 million KIU. |
3). Protocol of Erythropoietin Administration |
300 UI/Kg IV + 500 UI/Kg subcutaneously on admission followed by 500 UI/Kg subcutaneously every second day. |
+ Iron 325 mg PO 3 times a day | |
4). Retropriming |
Avoid hemodilution during priming of CPB by passive drainage of blood from venous system |
5). MiniCPB | CPB using centrifugal pump with small volume , in a closed circuit |