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Eur J Cardiothorac Surg 2007;32:401-402. doi:10.1016/j.ejcts.2007.04.017
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Is there any difference in lactate level between washed and unwashed donor blood during pediatric cardiopulmonary bypass?

Bingyang Jia,b,*, Jinping Liua

a Department of Pediatrics, Penn State Children's Hospital, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
b Department of Cardiopulmonary Bypass, Fuwai Hospital, Beijing, China

Received 12 March 2007; accepted 16 April 2007.

* Corresponding author. Address: Penn State College of Medicine, Department of Pediatrics – H085, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA. Tel.: +1 717 531 4647; fax: +1 717 531 0355. (Email: buj4{at}psu.edu).

Key Words: Pediatric • Cardiopulmonary bypass • Cell saver • Lactate • Hemoglobin

We read with great interest the recent paper by Swindell et al. [1]. The authors concluded that cell saver washing pack of red cell helps to prevent hyperkalemia during cardiopulmonary bypass (CPB) but does not prevent hyperlactaemia in neonates and infants undergoing cardiac surgery for complex congenital heart disease. We believe that their investigation is a good attempt to use cell saver processing of donor blood for pediatric patients before the CPB procedure. Such study may contribute to acid–base metabolism, electrolyte balances and anti-inflammatory strategies in pediatric patients in the near future.

Currently, packed red blood cells are an essential part of the CPB priming solution in small children and neonates. The storage media in packed red blood cells may cause significant acid–base, glucose, and electrolyte imbalances, which have been implicated in the development of severe complications [2]. Recent improvements such as cell saver and ultrafiltration have been used to process donor blood pre-CPB in adult patients [3]. Currently, modern cell saver devices used in clinical work have been designed for small volume blood, and present another option for processing donor blood for pediatric patients during CPB procedure.

We would like to make several comments concerning experimental design for this investigation. The authors stated that this study specifically focused on potassium and lactate level. However, in our opinion, authors neglect an important point: hemoglobin concentration, because there is a significant correlation between hemoglobin concentration and lactate level. Tissue perfusion and oxygenation during CPB is achieved by adjusting flow rate, temperature, gas flow, and hemoglobin to maintain oxygen delivery [4]. We need to know the exact hemoglobin concentration of the donor blood pre and post washing, and patients’ hemoglobin concentration at pre, during and post CPB as well. This is because during storage, red blood cells rapidly lose 2,3-bisphosphoglycerate (2,3-DPG) leading to an increase in the affinity for O2 and a temporary impairment of O2 transport [5]. If there is a significantly difference in hemoglobin concentration between washed and unwashed donor blood, it could have affect in the hemoglobin level of patients during and post the bypass and lead to a significant change on the oxygen metabolism and lactate level.

The results that we will present at Third International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion (May 17th–19th, 2007, in Hershey, PA, USA) on processing donor blood with a continuous auto transfusion system in neonates during CPB, show that the hematocrit in the processed blood was significantly higher than unprocessed blood before CPB. The levels of potassium, blood glucose, and lactate were significantly lower than in the unprocessed group at the beginning and the end of CPB. The hematocrit in processed group was better than unprocessed group, and the level of lactate in processed group was significantly less than unprocessed group.

We suggest that the authors consider using the hemoglobin as important index of these comparisons for their future experiments.

References

  1. Swindell CG, Barker TA, McGuirk SP, Jones TJ, Barron DJ, Brawn WJ, Horsburgh A, Willetts RG. Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease. Eur J Cardiothorac Surg 2007;31:659-664.[Abstract/Free Full Text]
  2. Keidan I, Amir G, Mandel M, Mishali D. The metabolic effects of fresh versus old stored blood in the priming of cardiopulmonary bypass solution for pediatric patients. J Thorac Cardiovasc Surg 2004;127:949-952.[Abstract/Free Full Text]
  3. Eichert I, Isgro F, Kiessling AH, Saggau W. Cell saver, ultrafiltration and direct transfusion: comparative study of three blood processing techniques. Thorac Cardiovasc Surg 2001;49:149-152.[CrossRef][Medline]
  4. Demers P, Elkouri S, Martineau R, Couturier A, Cartier R. Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation. Ann Thorac Surg 2000;70:2082-2086.[Abstract/Free Full Text]
  5. Hogman CF, Lof H, Meryman HT. Storage of red blood cells with improved maintenance of 2,3-bisphosphoglycerate. Transfusion 2006;46:1543-1552.[CrossRef][Medline]



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[Full Text] [PDF]

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