Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Lim HK (1), Wan HY (1), Chan TL (1), Yim CH (1), Fung SH (1), Wong LY(1)
Affiliation :
(1) Department of Cardiothoracic Surgery, Queen Mary Hospital
Introduction :
The Department of Cardiothoracic Surgery (CTSD) at Queen Mary Hospital performs the most open-heart surgeries in Hong Kong, approximately 700 cases annually and cardiopulmonary bypass (CPB) plays a vital role in these complex surgeries to temporarily take over the functions of the heart and lungs. However, CPB can lead to severe hemodilution and associated complications. Retrograde autologous priming (RAP) addresses this by using the patient's own blood to prime the bypass circuit, thereby maintaining adequate hematocrit levels and preserving essential coagulation factors.
Objectives :
To promote the implementation of RAP as a routine procedure in cardiopulmonary bypass within CTSD, with the aim of reducing the reliance of homologous blood transfusion and its associated risks.
Methodology :
This prospective study proposes investigating RAP in cardiac surgeries performed within CTSD. Patient data on demographics, preoperative and postoperative hematocrit level, intraoperative transfusion, post-operative complications and hospital stay would be collected from the intraoperative perfusion records and patient medical records. A comparison would be made between group receiving RAP and a control group which did not receive RAP.
Result & Outcome :
The implementation of RAP has shown benefit in reducing homologous blood transfusion in previous studies, we anticipate similar results in our patient population. While specific results for analysis are still pending, no blood transfusion was required intraoperatively in a case where retrograde autologous priming was implemented during cardiac surgery. This single case demonstrated the potential of RAP in maintaining intraoperative hematocrit level and minimize the need for homologous blood transfusion. While this is based on a single case and cannot be generalized, this provides preliminary indications of potential benefits of RAP. We expect that the utilization of RAP would lead to a decrease in intraoperative transfusion and potentially reduce the postoperative complications, such as acute kidney injury.
The preliminary utilization of retrograde autologous priming in a single case demonstrated a successful prevention of blood transfusion during cardiopulmonary bypass. Further research is needed to validate the potential of RAP in reducing transfusion requirement. Overall, implementing RAP as routine procedure has the potential to minimize the use of homologous blood transfusion and its related risks in cardiac surgeries.
