Impact of Intravascular Fluid Resuscitation for Acute Normovolemic Hemodilution on Blood Viscosity and Oxygen Delivery in Coronary Artery Bypass Graft Surgery
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 21
- Locations
- 1
- Primary Endpoint
- blood viscosity at shear rate 5/sec
Study Overview
Brief Summary
Acute normovolemic hemodilution (ANH) has long been employed for reducing allogenic blood transfusion for cardiac surgery, and hydroxyethyl starch has been used as an intravenous replacement fluid during ANH procedure. However, possible impact of ANH employing HES on blood viscosity and oxygen delivery have not been well investigated in patients undergoing off-pump coronary artery bypass (OPCAB) surgery .
Anesthesia is induced and maintained by using propofol-remifentanil-rocuronium in OPCAB surgery (n=21). ANH is performed by using 5 ml/kg of blood salvage and administering 5 ml/kg of balanced HES 130/0.42 (Tetraspan™) for 15 min during vascular graft harvesting. For the present study, three arterial blood samples (3 ml each) are taken before (Sample 1) and after ANH (sample 2 and 3) and they are stored in 3 tubes. Sample 3 (in tube) undergoes further 30% in-vitro dilution by adding 1-1.5 ml HES. By using a scanning capillary tube viscometer (Hemovister™), Blood viscosity at low shear rate (5/sec) of the three samples are determined. By using a formula with blood viscosity and hematocrit, tissue O2 delivery index (TODI, = hematocrit/viscosity at 5/sec) is calculated.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Factorial
- Primary Purpose
- Supportive Care
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •patients undergoing off-pump coronary artery bypass graft surgery
Exclusion Criteria
- •Preoperative anemia
- •LV ejection fraction < 50%
Arms & Interventions
Acute normovolemic hemodilution
acute normovolemic hemodilution by using hydroxyethyl starch
Intervention: acute normovolemic hemodilution (Procedure)
Acute normovolemic hemodilution
acute normovolemic hemodilution by using hydroxyethyl starch
Intervention: In-vitro hemodilution (Procedure)
In-vitro hemodilution
adding additional hydroxyethyl starch for achieving further 30% dilution of whole blood sample which already underwent ANH of 4-6 ml/kg.
Intervention: In-vitro hemodilution (Procedure)
Outcomes
Primary Outcomes
blood viscosity at shear rate 5/sec
Time Frame: 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution
By using a scanning capillary tube viscometer (Hemovister™), Blood viscosity at shear rate 5/sec of the three samples are determined
hematocrit/blood viscosity at 5/sec
Time Frame: 5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution
oxygen delivery index calculated with a formula (= hematocrit/blood viscosity)
Secondary Outcomes
- blood viscosity at shear rate 300/sec(5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution)
- Coagulation profiles in ROTEM(5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution)
- Hematocrit/viscosity at shear rate 300/sec(5 min after acute normovoelmic hemodilution, 5 min after in-vitro dilution)
Investigators
Tae-Yop Kim, MD PhD
Professor of Anesthesiology
Konkuk University Medical Center