Comparative Analysis Between Ringer's Lactate vs Plasma Lyte-A as Cardiopulmonary Bypass Prime

Summary

Metabolic acidosis is a frequent problem in cardiopulmonary bypass. The cause is poorly understood, but it appears to be multifactorial. It is assumed to be result of hypoperfusion with resultant lactatemia. And other theories include bicarbonate dilution to excessive proton activity and diluting fluid.The main three contributors for the development of metabolic acidosis are stress of anaesthesia, surgery and Cardio Pulmonary Bypass(CPB) prime.Even after research discussion and debate, there is no agreement upon ideal prime.The literature is extensive, comparing different types of colloids, colloids versus crystalloids, synthetic versus organic, and inclusion of numerous additions in an attempt to make a grossly unphysiological state the least disruptive to the body as possible

Timeline

Start

2017-02-10

Primary completion

2017-09

Completion

2017-09

Publications

• Results Hett DA, Smith DC. A survey of priming solutions used for cardiopulmonary bypass. Perfusion. 1994 Jan;9(1):19-22. doi: 10.1177/026765919400900104.
• Results Gu YJ, Boonstra PW. Selection of priming solutions for cardiopulmonary bypass in adults. Multimed Man Cardiothorac Surg. 2006 Jan 1;2006(109):mmcts.2005.001198. doi: 10.1510/mmcts.2005.001198.
• Results Morgan TJ, Power G, Venkatesh B, Jones MA. Acid-base effects of a bicarbonate-balanced priming fluid during cardiopulmonary bypass: comparison with Plasma-Lyte 148. A randomised single-blinded study. Anaesth Intensive Care. 2008 Nov;36(6):822-9. doi: 10.1177/0310057X0803600611.
• Results Lang W, Zander R. Prediction of dilutional acidosis based on the revised classical dilution concept for bicarbonate. J Appl Physiol (1985). 2005 Jan;98(1):62-71. doi: 10.1152/japplphysiol.00292.2004.
• Results Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore). 1977 Jan;56(1):38-54.
• Results De Jonghe B, Cheval C, Misset B, Timsit JF, Garrouste M, Montuclard L, Carlet J. Relationship between blood lactate and early hepatic dysfunction in acute circulatory failure. J Crit Care. 1999 Mar;14(1):7-11. doi: 10.1016/s0883-9441(99)90002-3.
• Results Lilley A. The selection of priming fluids for cardiopulmonary bypass in the UK and Ireland. Perfusion. 2002 Sep;17(5):315-9. doi: 10.1191/0267659102pf538oa.
• Results Liskaser FJ, Bellomo R, Hayhoe M, Story D, Poustie S, Smith B, Letis A, Bennett M. Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis. Anesthesiology. 2000 Nov;93(5):1170-3. doi: 10.1097/00000542-200011000-00006.
• Results Alston RP, Theodosiou C, Sanger K. Changing the priming solution from Ringer's to Hartmann's solution is associated with less metabolic acidosis during cardiopulmonary bypass. Perfusion. 2007 Nov;22(6):385-9. doi: 10.1177/0267659108089142.
• Results Murray DM, Olhsson V, Fraser JI. Defining acidosis in postoperative cardiac patients using Stewart's method of strong ion difference. Pediatr Crit Care Med. 2004 May;5(3):240-5. doi: 10.1097/01.pcc.0000112367.50051.3b.

Drugs

Indications

No indication recorded.