Abstract
Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an accurate prediction is required. However, the standard prediction equation often results in actual values that are lower than the predicted values. This study aimed to clarify the limits of agreement (LOA) and bias of the prediction equations and investigate better the prediction equations. A retrospective study was performed on adult patients between April 2015 and December 2020. Study 1 included 158 patients, and Study 2 included 55 patients. The primary outcomes were the LOA and bias between the predicted and measured Hct values after the initiation of CPB, and two studies were conducted. In Study 1, total blood volume (TBV) was estimated, and the new blood volume index (BVI) was calculated. BVI was also evaluated for the overall value and gender differences. Therefore, the patient’s background was compared by gender differences. In, Study 2 the conventional predicted equation (Eq. 1), the predicted equation using the new BVI (Eq. 2), and the predicted equation using the new BVI including physiological factors in the TBV equation (Eq. 3) were compared. In Study 1, BVI was 53 (44–67) mL/kg. In Study 2, bias ± LOA was − 2.5 ± 6.8% for Eq. 1, 0.1 ± 6.6% for Eq. 2, and 0.4 ± 6.2% for Eq. 3. The new equation is expected to predict the Hct value after the initiation of CPB with better LOA and bias than the conventional equation.
Similar content being viewed by others
Abbreviations
- BMI:
-
Body mass index
- BVI:
-
Blood volume index
- CPB:
-
Cardiopulmonary bypass
- Hct:
-
Hematocrit
- LOA:
-
Limits of agreement
- TBV:
-
Total blood volume
References
DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, Forest RJ, Pieroni JW, Warren CS, Bogosian ME, Krumholz CF, Clark C, Clough RA, Weldner PW, Lahey SJ, Leavitt BJ, Marrin CAS, Charlesworth DC, Marshall P, O’Connor GT. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Ann Thorac Surg. 2001;71:769–76.
Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg. 2003;76:784–91.
Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg. 2003;125:1438–50.
Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, Djaiani G, Ivanov J, Karski J, David TE. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg. 2005;129:391–400.
Karkouti K, Djaiani G, Borger MA, Beattie WS, Fedorko L, Wijeysundera D, Ivanov J, Karski J. Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac Surgery. Ann Thorac Surg. 2005;80:1381–7.
Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg. 2002;74:1180–6.
Horvath KA, Acker MA, Chang H, Bagiella E, Smith PK, Iribarne A, Kron IL, Lackner P, Argenziano M, Ascheim DD, Gelijns AC, Michler RE, Patten DV, Puskas JD, O’Sullivan K, Kliniewski D, Jeffries NO, O’Gara PT, Moskowitz AJ, Blackstone EH. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg. 2013;95:2194–201.
Goldberg JB, Shann KG, Fitzgerald D, Fuller J, Paugh TA, Dickinson TA, Paone G, Prager RL, Likosky DS. The relationship between intra-operative transfusions and nadir hematocrit on post-operative outcomes after cardiac surgery. J Extra Corpor Technol. 2016;48:188–93.
LaPar DJ, Hawkins RB, McMurry TL, Isbell JM, Rich JB, Speir AM, Quader MA, Kron IL, Kern JA, Ailawadi G. Investigators for the virginia cardiac services quality initiative. Preoperative anemia versus blood transfusion: Which is the culprit for worse outcomes in cardiac surgery? J Thorac Cardiovasc Surg. 2018;156:66–74.
Cooper John R, Giesecke NMartin Jr. Cardiopulmonary Bypass. 2nd ed. Philadelphia: Lippincott Williams Wilkins; 2000. p. 186–96.
Feldschuh J, Enson Y. Prediction of the normal blood volume. Relation of blood volume to body habitus. Circulation. 1977;56:605–12.
Anonymous. Recommended methods for measurement of red-cell and plasma volume. J Nucl Med. 1980;21:793–800.
Davy KP, Seals DR. Total blood volume in healthy young and older men. J Appl Physiol. 1994;76:2059–62.
Lemmens HJ, Bernstein DP, Brodsky JB. Estimating blood volume in obese and morbidly obese patients. Obes Surg. 2006;16:773–6.
Jia ZS, Xie HX, Yang J, Liu XM, Sun ZQ, Li J, Wang Z, Hou XT. Total blood volume of Asian patients undergoing cardiac surgery is far from that predicted by conventional methods. J Cardiovasc Surg (Torino). 2013;54:423–30.
Hilberath JN, Thomas ME, Smith T, Jara C, Fitzgerald DJ, Wilusz K, Liu X, Muehlschlegel JD. Blood volume measurement by hemodilution: association with valve disease and re-evaluation of the Allen formula. Perfusion. 2015;30:305–11.
Hilberath JN, Smith T, Jara C, Fitzgerald DJ, Muehlschlegel JD. Blood volume in cardiac surgery with cardiopulmonary bypass. Perfusion. 2015;30:395–9.
Chen J, Gorman M, O’Reilly B, Chen Y. Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients. Clin Biochem. 2016;49:708–12.
Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statistician. 1983;32:307–17.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.
Giavarina D. Understanding Bland Altman analysis. Biochem Med. 2015;25:141–51.
Trowbridge C, Stammers A, Klayman M, Brindisi N. A novel calculation to estimate blood volume and hematocrit during bypass. J Extra Corpor Technol. 2008;40:61–4.
Manzone TA, Dam HQ, Soltis D, Sagar VV. Blood volume analysis: a new technique and new clinical interest reinvigorate a classic study. J Nucl Med Technol. 2007;35:55–63.
Ministry of Health, Labour and Welfare Title of subordinate document. In: National Health and Nutrition Survey in Japan. 2019. https://www.mhlw.go.jp/content/000710991.pdf. 117–20. Accessed 1 Mar 2021.
Coetzee AR, Coetzee JF. Predicting the need for blood during cardiopulmonary bypass. South Afr J Anaesth Analg. 2005;11:7–13.
Erpicum M, Dardenne N, Hans G, Larbuisson R, Defraigne JO. Prediction of the post-dilution hematocrit during cardiopulmonary bypass. Are new formula needed? Perfusion. 2016;31:458–64.
Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, Hessel EA II, Haan CK, et al. Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg. 2011;2011:944–82.
The Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA). EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg. 2017;2018:79–111.
Acknowledgements
We thank all the staff at the Departments of Clinical Engineering and Cardiovascular Surgery for the careful and helpful support to this study.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hasegawa, T., Iba, Y., Naraoka, S. et al. Improvement of predicted hematocrit values after the initiation of cardiopulmonary bypass in cardiovascular surgery. J Artif Organs 25, 117–124 (2022). https://doi.org/10.1007/s10047-021-01295-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10047-021-01295-z