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9research-artic0le2020 6043PRF0010.1177/0267659120906043PerfusionSteel and Bui
Original Paper
Reprinted with kind permission from the journal – PERFUSION
Contemporary Australian priming constituents for adult perfusion centres: a survey
Rona Steel and Tri Bui
Abstract
Aim: Evidence for the ideal/best practice priming solution remains meagre and largely historical. The aim of this survey was to determine the constituents of contemporary priming solutions in adult open-heart centres across Australia. This would provide insight on the level of variation within current Australian priming practices and inform perfusionists of how their current priming methods compare to the spectrum of Australian practice.
Method: A total of 15 survey questions covering various aspects of priming constituents were sent via email to perfusionists in all 63 adult open-heart centres across Australia.
Results: This prime survey received a 100% response rate across Australia. All units prime with a balanced physiological solution, 73% of units prime with Plasma-Lyte 148 and 19% with Hartmann’s solution. No synthetic colloids are used for priming in Australia. Up to 6,520 (30%) cases per annum receive heparin as the only additive to their prime base solution. All other cases had various combinations of sodium bicarbonate, mannitol and albumin added for a variety of recorded reasons.
Conclusion: Contemporary Australian priming practices show a marked level of conformity between units. Variation exists in the rationale for adding sodium bicarbonate, mannitol and albumin. Further investigations into the clinical effects of these additives are required to determine if the rationale for their addition is historical or judicious in this contemporary era of low prime volumes, physiological base solutions and coated bypass circuits.
Keywords
prime; cardiopulmonary bypass; Australian; solution; perfusion
Perfusion 2020, Vol. 35(8) 778–785 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions httpDs:O//dIo: i1.o0r.g1/107.171/0772/60726756951921029090066043 journals.sagepub.com/home/prf
Introduction
Since the inception of open-heart surgery, every proce- dure using a heart–lung machine (HLM) has required a solution to prime the components of the bypass circuit. This priming solution is necessary to deair the bypass circuit prior to the commencement of cardiopulmonary bypass (CPB) when it rapidly mixes with the patients’ blood to facilitate the surgical procedure.
The scarcity of evidence1–5 for an ideal priming solu- tion is surprising considering its necessity in all open- heart operations and the potentially profound impact of 1,500-2,500 mL of this solution on the patient’s physiol- ogy during the operation and beyond.
Minimising the volume of the prime solution has been our departmental focus in recent years in accord- ance with overwhelming contemporary evidence.6 This is to reduce hemodilution and improve patient out- comes. With this being achieved, our unit then focused on reviewing the constituents of this priming solution.
Internationally, there is great variation in priming solu- tions2,3,7 with little guidance on how prime ingredients are selected. Furthermore, a survey of priming practices across Australia has never been performed and there is little published material on international surveys detail- ing prime ingredients.7
The aim of this survey was to determine contempo- rary priming solutions and constituents of adult open- heart centres across Australia. This survey would provide insight on the level of conformity or variation in current Australian practice and inform Australian insti- tutions on their practice relative to their peers in the
Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia
Corresponding author:
Rona Steel, Department of Anaesthesia, Westmead Hospital, Hawkesbury Road, Sydney, NSW 2145, Australia.
Email: ronasteel@yahoo.com
29 NOVEMBER 2021 | www.anzcp.org