Hemodynamic and echocardiographic effects of hemofiltration performed during cardiopulmonary bypass

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.