N. Blanchard et al., Hemodynamic and echocardiographic effects of hemofiltration performed during cardiopulmonary bypass, J CARDIOTHO, 14(4), 2000, pp. 393-398
Objective: To evaluate the effects of hemofiltration performed during rewar
ming before emergence from cardiopulmonary bypass on hemodynamic and echoca
rdiographic parameters.
Design: Prospective randomized study; blind analysis of echocardiographic p
arameters and hemodynamic parameters.
Setting: Single-center study performed in a university hospital.
Participants: Two groups of 13 adult patients undergoing coronary artery by
pass graft surgery.
Intervention: Patients were randomized to conventional procedure or hemofil
tration performed with a polysulfone hemofilter. Hemofiltration, started at
the time of rewarming on cardiopulmonary bypass, was performed with a flow
rate adjusted to achieve an ultrafiltrate volume of 15 mL/kg on completion
of rewarming,
Measurements and Main Results: Hemodynamic (systemic mean arterial pressure
, right atrial pressure, heart rate) and echocardiographic parameters (shor
tening fraction, segmental kinetic score, cardiac output, systemic vascular
resistance) were measured before and after hemofiltration and on arrival i
n the intensive care unit. Heart rate and cardiac index were increased sign
ificantly in both groups during the postoperative period. In the control gr
oup, systemic vascular resistance was decreased significantly, and cardiac
index was increased during the postoperative period, together with signific
ant alterations of segmental kinetic score and shortening fraction. In the
hemofiltration group, systemic vascular resistance remained unchanged, asso
ciated with a significantly improved segmental kinetic score compared with
the control group.
Conclusions: Hemofiltration performed during rewarming before emergence fro
m cardiopulmonary bypass is associated with stability of hemodynamic parame
ters and improved segmental myocardial kinetics. Copyright (C) 2000 by W,B,
Saunders Company.