Coronary Artery Disease, Ischemic Heart Disease
Conditions
Keywords
acute normovolemic hemodilution, coronary artery bypass graft surgery, hydroxyethyl starch, blood viscosity
Brief summary
Acute normovolemic hemodilution (ANH) has long been employed for reducing allogenic blood transfusion for cardiac surgery, and hydroxyethyl starch has been used as an intravenous replacement fluid during ANH procedure. However, possible impact of ANH employing HES on blood viscosity and oxygen delivery have not been well investigated in patients undergoing off-pump coronary artery bypass (OPCAB) surgery . Anesthesia is induced and maintained by using propofol-remifentanil-rocuronium in OPCAB surgery (n=21). ANH is performed by using 5 ml/kg of blood salvage and administering 5 ml/kg of balanced HES 130/0.42 (Tetraspan™) for 15 min during vascular graft harvesting. For the present study, three arterial blood samples (3 ml each) are taken before (Sample 1) and after ANH (sample 2 and 3) and they are stored in 3 tubes. Sample 3 (in tube) undergoes further 30% in-vitro dilution by adding 1-1.5 ml HES. By using a scanning capillary tube viscometer (Hemovister™), Blood viscosity at low shear rate (5/sec) of the three samples are determined. By using a formula with blood viscosity and hematocrit, tissue O2 delivery index (TODI, = hematocrit/viscosity at 5/sec) is calculated.
Interventions
PROCEDUREacute normovolemic hemodilution
acute normovolemic hemodilution (ANH) is performed by using 5 ml/kg of blood salvage and intravenously administering 5 ml/kg of balanced hydroxyethystarch 130/0.42 (Tetraspan™) for 15 min
PROCEDUREIn-vitro hemodilution
Blood sample after ANH 5 ml/kg undergoes further 30% in-vitro dilution by adding 1-1.5 ml hydroxyethystarch 130/0.42
Sponsors
Konkuk University Medical Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Acute normovolemic hemodilution consists of phlebotomy and intravascular volume resuscitation by using crystalloid/colloid in a same amount of phlebotomy
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* patients undergoing off-pump coronary artery bypass graft surgery
Exclusion criteria
* Preoperative anemia * LV ejection fraction \< 50%
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| blood viscosity at shear rate 5/sec | 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution | By using a scanning capillary tube viscometer (Hemovister™), Blood viscosity at shear rate 5/sec of the three samples are determined |
| hematocrit/blood viscosity at 5/sec | 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution | oxygen delivery index calculated with a formula (= hematocrit/blood viscosity) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| blood viscosity at shear rate 300/sec | 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution | By using a scanning capillary tube viscometer (Hemovister™), Blood viscosity at shear rate 300/sec of the three samples are determined |
| Hematocrit/viscosity at shear rate 300/sec | 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution | oxygen delivery index calculated with a formula (= hematocrit/blood viscosity) |
| Coagulation profiles in ROTEM | 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution | clot formation time in extem, MCF in extemA5 in fibtem, |
Countries
South Korea
Outcome results
None listed