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See detailEfficacy of the RemoweLL cardiotomy reservoir for fat and leucocyte removal from shed mediastinal blood: a randomized controlled trial.
LAGNY, Marc-Gilbert ULg; GOTHOT, André ULg; HANS, Grégory ULg et al

in Perfusion (2016)

Efficacy of the RemoweLL cardiotomy reservoir for Fat and Leucocyte removal from shed mediastinal blood: a randomized controlled trial. ABSTRACT (176 words) Introduction Re-transfusion of lipid particles ... [more ▼]

Efficacy of the RemoweLL cardiotomy reservoir for Fat and Leucocyte removal from shed mediastinal blood: a randomized controlled trial. ABSTRACT (176 words) Introduction Re-transfusion of lipid particles and activated leucocytes with shed mediastinal blood (SMB) can aggravate cardiopulmonary bypass-associated inflammation and increase the embolic load. This study evaluated the fat and leucocyte removal capacity of the RemoweLL cardiotomy reservoir. Methods Forty-five patients undergoing elective on-pump cardiac surgery were randomly allocated to filtration of SMB using the RemoweLL or the Admiral cardiotomy reservoir. The primary outcome was the drop in leucocytes and lipid particles obtained with the two filters. The effect of the filters on other blood cells and inflammatory mediators such as myeloperoxidase (MPO) was also assessed. Results The RemoweLL cardiotomy filter removed 16.5 % of the leucocytes (P < 0.001) while no significant removal of leucocytes was observed with the Admiral (P = 0.48). The percentage reductions in lipid particles were similar in the two groups (26% vs 23 %, P = 0.2). Both filters similarly affected the level of MPO (P = 0.71). Discussion The RemoweLL filter more effectively removed leucocytes from SMB than the Admiral. It offered no advantage in term of lipid particle clearance. [less ▲]

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See detailLeucocytes and lipid particles filtration in suction blood during cardiopulmonary bypass: impact on kidney function evaluated with a monocentric prospective randomized study.
LAGNY, Marc-Gilbert ULg; KOCH, Jean-Noël ULg; BLAFFART, Francine ULg et al

Conference (2015, October 03)

OBJECTIVE: Cardiac surgery may be complicated by acute kidney injury (AKI). Cardiotomy suction during cardiopulmonary bypass (CPB) is deleterious. A few studies have demonstrated that shed mediastinal ... [more ▼]

OBJECTIVE: Cardiac surgery may be complicated by acute kidney injury (AKI). Cardiotomy suction during cardiopulmonary bypass (CPB) is deleterious. A few studies have demonstrated that shed mediastinal blood (SMB) suction during cardiopulmonary bypass (CPB) can increase inflammatory response and lipids emboli. These 2 factors contribute to the development of postoperative AKI. The RemoweLL (RemoweLeucoLipids, Eurosets™, Italy) filter is a recent designed cardiotomy with a multilayer filter for activated leucocytes filtration and a syphon for lipid particles sequestration. The SMB can be collected and filtered in this supplementary cardiotomy added to CPB circuit. The aim of this monocentric prospective study was to compare the specific RemoweLL cardiotomy filtration for suction blood during CPB and a conventional 40 µm filter (Admiral, Eurosets™, Italy). The primary goal was to evaluate the AKI within 48 hours after surgery using the Acute Kidney Injury Network classification (AKIN classification) but also measuring early specific biomarkers of AKI: serum Cystatine C and urinary neutrophil gelatinase-associated lipocalin (NGAL). METHODS: Sixty patients scheduled for elective cardiac surgery (aortic or mitral valvular combined or not with coronary bypass grafting) with a glomerular filtration rate (GFR) > 45mL/min. were randomly into 2 groups for SMB filtration: - Groupe 1 (n=30) with RemoweLL cardiotomy (Leucocytes and lipids filter); - Groupe 2 (n=30) with Admiral cardiotomy (conventional 40 µm filter). All components: venous reservoir, oxygenator and surface treatment were similar in both groups. [less ▲]

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See detailVeno-venous extracorporeal CO2 removal improves pulmonary hemodynamics in a porcine ARDS model
MORIMONT, Philippe ULg; GUIOT, Julien ULg; Desaive, Thomas ULg et al

in Acta Anaesthesiologica Scandinavica (2015)

BACKGROUND: Protective lung ventilation is recommended in patients with acute respiratory distress syndrome (ARDS) to minimize additional injuries to the lung. However, hypercapnic acidosis resulting from ... [more ▼]

BACKGROUND: Protective lung ventilation is recommended in patients with acute respiratory distress syndrome (ARDS) to minimize additional injuries to the lung. However, hypercapnic acidosis resulting from ventilation at lower tidal volume enhances pulmonary hypertension and might induce right ventricular (RV) failure. We investigated if extracorporeal veno-venous CO2 removal therapy could have beneficial effects on pulmonary circulation and RV function. METHODS: This study was performed on an experimental model of ARDS obtained in eight anaesthetized pigs connected to a volume-cycled ventilator. A micromanometer-tipped catheter was inserted into the main pulmonary artery and an admittance micromanometer-tipped catheter was inserted into the right ventricle. RV-arterial coupling was derived from RV pressure-volume loops. ARDS was obtained by repeated bronchoalveolar lavage. Protective ventilation was then achieved, and the pigs were connected to a pump-driven extracorporeal membrane oxygenator (PALP, Maquet, Germany) in order to achieve CO2 removal. RESULTS: ARDS induced severe hypercapnic acidosis. Systolic pulmonary artery pressure significantly increased from 29.6 ± 1.8 to 43.9 ± 2.0 mmHg (P < 0.001). After the PALP was started, acidosis was corrected and normocarbia was maintained despite protective ventilation. Pulmonary artery pressure significantly decreased to 31.6 ± 3.2 mmHg (P < 0.001) and RV-arterial coupling significantly improved (RV-arterial coupling index = 1.03 ± 0.33 vs. 0.55 ± 0.41, P < 0.05). CONCLUSION: Veno-venous CO2 removal therapy enabled protective ventilation while maintaining normocarbia during ARDS. CO2 removal decreased pulmonary hypertension and improved RV function. This technique may be an effective lung- and RV-protective adjunct to mechanical ventilation. [less ▲]

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See detailCardiac surgery and acute kidney injury.
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; KOCH, Jean-Noël ULg et al

Conference given outside the academic context (2013)

Lecture about Cardiac surgery and acute kidney injury. Presentations of results about a retrospective study performed in the University Hospital of Liège and presentations about the protocol of a ... [more ▼]

Lecture about Cardiac surgery and acute kidney injury. Presentations of results about a retrospective study performed in the University Hospital of Liège and presentations about the protocol of a prospective study on the same topic. [less ▲]

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See detailQuel est l'avenir de la profession de perfusionniste?
BLAFFART, Francine ULg

Conference (2013, September)

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See detailCPB AND AORTIC SURGERY: From a theoretical approach to a practical approach
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg

Conference given outside the academic context (2013)

Background Despite recent improvements in prevention, medical treatment [1]and endovascular aortic repair , invasive surgery associated with cardiopulmonary bypass (CPB) remains the best option of ... [more ▼]

Background Despite recent improvements in prevention, medical treatment [1]and endovascular aortic repair , invasive surgery associated with cardiopulmonary bypass (CPB) remains the best option of treatment for some patients. The aim of this study is to make a review of the specific CPB protocols associated with these invasive surgical approaches, based on our clinical experience and according to the recent literature. Up to now, these protocols are not supported by evidence based in medicine (EBM) [2] or in perfusion (EBP). Discrepancies can be observed regarding target temperature , selective cerebral protection , CPB circuit concept and arterial cannulation sites . Variables guidelines are suggested concerning regional flow , transfusion requirements [3], coagulation monitoring blood gas management[4] as for cerebral and CPB monitoring tools. Conclusions In the absence of EBM and EBP in the aortic surgery field, the short and long terms clinical outcomes of the patients elected to invasive surgery for aortic diseases must guide and substantiate our choices of techniques and of CPB protocols. [less ▲]

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See detailLa CEC en 2013: Etat de l'art
BLAFFART, Francine ULg

Conference (2013, March)

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See detailL'insuffisance rénale aiguë dans le décours d'une chirurgie cardiaque adulte: incidence au Centre Hospitalier Universitaire de Liège
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Scientific conference (2012, November 20)

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de ... [more ▼]

Cadre théorique En chirurgie cardiaque, l’insuffisance rénale aiguë (IRA) est une complication postopératoire sévère et est associée à une augmentation du taux de mortalité, de morbidité et des durées de séjour aux soins intensifs (SI). Elle survient dans 5 à 30 % des cas selon le type de définition utilisée (1,2). Objectifs L’objectif de cette étude est de présenter un état des lieux de l’IRA survenant dans le décours d’une chirurgie cardiaque, dans notre Centre. Matériel et Méthodes Cette étude rétrospective inclut des patients pris en charge pour une chirurgie cardiaque entre le 1er avril 2008 et le 31 mars 2009. Les patients sélectionnés sont des opérés de : pontages aorto-coronaires avec CEC (PAC CEC), pontages aorto-coronaires à cœur battant (PAC battant), remplacement valvulaire aortique (RVA), remplacement ou réparation valvulaire mitral (RVM), ou remplacement valvulaire aortique associé à des pontages aorto-coronaires (RVA+PAC). Les insuffisants rénaux chroniques dialysés, en période préopératoire, sont exclus. La classification RIFLE (Risk, Injury, Failure, Loss and End stage kidney disease) permet de stratifier les patients en trois grades de sévérité d’IRA. Cette stratification est basée sur l’élément le plus péjoratif observé durant les 7 premiers jours postopératoires : augmentation du niveau de créatinine sérique ou diminution de la diurèse, ou diminution de la filtration glomérulaire selon les critères définis par Bellomo (3). La fréquence d’IRA est étudiée par type de chirurgie ainsi que son impact sur les durées de séjour aux SI et hospitalier. Les proportions sont comparées par un test du Chi2 et les valeurs médianes par un test U de Mann Whitney. Les résultats sont considérés comme étant significatifs au niveau d’incertitude de 5% (p<0.05). Résultats Quatre cent trente-quatre patients sont inclus : âge médian (interquartiles) 69.0 (60.0-76.0) ans, 30.2% de femmes, 2.76 de cas urgents. Cinquante-huit patients (13.4%) sont opérés par la technique PAC battant, 182 (41.9%) PAC CEC, 104 (24.0%) RVA, 44 (10.1%) RVM et 46 (10.6%) RVA+PAC. Une IRA est diagnostiquée chez 213 (49.1%) patients : 79 (37.1%) « Risk », 108 (50.7%) « Injury » et 26 (12.2%) « Failure ». La distribution d’IRA par type de chirurgie est respectivement égale à 36.2% pour le groupe PAC battant, 44.0% PAC CEC, 49.0% RVA, 52.3 RVM et 82.6% RVA+PAC. La fréquence d’IRA diffère significativement selon le type d’intervention chirurgicale (p<0.0001). Les durées de séjour aux SI sont statistiquement plus longues (p<0.0001) pour le groupe de patients ayant développé une IRA, respectivement : 3(2-4) jours versus 2(2-3) jours. Cependant, il n’y a pas de différence (p=0.65) observée entre les deux groupes (IRA et non IRA) en termes de durées de séjour hospitalier : 13 (10-18) jours versus 12 (10-16) jours. Discussion L’incidence d’IRA est très élevée dans cette population de patients, comparée aux données disponibles dans la littérature. Cela est probablement dû au fait que les trois éléments de la classification RIFLE ont été utilisés sur toute la population de l’étude. Conclusions L’IRA après chirurgie cardiaque associée à la CEC devrait être étudiée, à l’avenir pour développer des mesures préventives pour réduire les IRA. [less ▲]

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See detailMultimodality blood conservation strategy in cardiac surgery with cardiopulmonary bypass: the CHU of Liege experience
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, November 20)

This study presents the transfusion rates of cardiac surgery patients and describes the in-house strategy of blood conservation applied in a single centre

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See detailPostoperative bleeding and autotransfusion
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, November 20)

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic ... [more ▼]

Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleedings could potentially be saved with a cell salvage device. This practice may contribute to decreased allogeneic transfusion. This study explores the effectiveness of a chest drainage system combined with a cell salvage option during the postoperative period of cardiac surgery in patients at high risk of bleeding [less ▲]

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See detailL'épargne sanguine: un enjeu actuel
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

in Revue Médicale de Liège (2012), 67(11), 593-596

In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development ... [more ▼]

In view of the demographic evolution, the progress of quality requirements and the shortage of donors, a deficiency of blood components is to be feared in the coming years.. This implies the development of a blood conservation strategy, the revision of transfusion practices and the implementation of preventive measures to limit transfusion requirements. Each department caring for patients at high transfusion risk should assess and rationalize its transfusion practices in a structured multidisciplinary way [less ▲]

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See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, October 27)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass, in our center. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed stratifying the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Mann-Whitney U test. Results were considered significant at p < 0.05. Results: Four hundred and thirty-four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Distribution of AKI by type of surgery was equal to 36.2% among OPCABG, 44.0% on-pump CABG, 49.0% aortic valve replacement, 52.3% mitral valve surgery and 82.6% aortic valve replacement combined with CABG, respectively. AKI occurrences differed significantly according to the type of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. However, no difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used. This study emphasizes the need for clear definition of AKI in order to compare different studies adequately. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

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See detailCPB AND AORTIC SURGERY The state of the Art (From a Theoritical to a Practical Approach)
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg

Conference (2012, October 04)

Background Despite recent improvements in prevention, medical treatment [1]and endovascular aortic repair , invasive surgery associated with cardiopulmonary bypass (CPB) remains the best option of ... [more ▼]

Background Despite recent improvements in prevention, medical treatment [1]and endovascular aortic repair , invasive surgery associated with cardiopulmonary bypass (CPB) remains the best option of treatment for some patients. The aim of this study is to make a review of the specific CPB protocols associated with these invasive surgical approaches, based on our clinical experience and according to the recent literature. Up to now, these protocols are not supported by evidence based in medicine (EBM) [2] or in perfusion (EBP). Discrepancies can be observed regarding target temperature , selective cerebral protection , CPB circuit concept and arterial cannulation sites . Variables guidelines are suggested concerning regional flow , transfusion requirements [3], coagulation monitoring blood gas management[4] as for cerebral and CPB monitoring tools. Conclusions In the absence of EBM and EBP in the aortic surgery field, the short and long terms clinical outcomes of the patients elected to invasive surgery for aortic diseases must guide and substantiate our choices of techniques and of CPB protocols. [less ▲]

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See detailCardiac surgery and acute kidney injury: retrospective study
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; Defraigne, Jean-Olivier ULg et al

Conference (2012, September 29)

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units ... [more ▼]

Background: In cardiac surgery, acute kidney injury (AKI) is a severe postoperative complication and associated with increased rates of mortality, morbidity, and length of stay in intensive care units (ICU). It occurs in 5% to 30% of patients depending on the definition used [1] [2] [3]. The aim of this study is to present an overview of AKI following cardiac surgery associated or not with cardiopulmonary bypass. Methods: This retrospective study includes patients treated by cardiac surgery from April 1st, 2008 to March 31th, 2009 in a single center. We selected patients who underwent on-pump coronary artery bypass surgery (CABG), off-pump CABG (OPCAB), aortic valve replacement, mitral valve repair or replacement and aortic valve replacement combined with CABG. Patients undergoing renal replacement therapy preoperatively were excluded. The RIFLE classification (Risk, Injury, Failure, Loss and End stage kidney disease) allowed to stratify the patients into the 3 grades of AKI severity. The stratification was based on the most pejorative element observed within 7 days after surgery: increased serum creatinine level or decreased urine output, or decreased glomerular filtration rate according to criteria of Bellomo [4]. Occurrence of AKI was studied by type of cardiac surgery as its impact on the length of stay in ICU and in the hospital. Proportions were compared by the Chi-square test and median values by the Kruskal-Wallis. Results were considered significant at p < 0.05. Results: Four hundred and thirty four patients were included: median (IQR) age 69.0(60.0-76.0) year, 30.2% females, 2.76% urgent/emergent cases. Fifty-eight patients (13.4%) underwent OPCAB, 182(41.9%) on-pump CABG, 104(24.0%) aortic valve replacement, 44(10.1%) mitral valve repair or replacement and 46(10.6%) aortic valve replacement combined with CABG. AKI occurred in 213(49.1%) patients: 79(37.1%) “Risk”, 108(50.7%) “Injury” and 26(12,2%) “Failure”. Occurrence of AKI after OPCAB was 21(9.86%), CABG 80(37.6%), aortic valve replacement 51(23.9%), mitral valve surgery 23(10.8%) and aortic valve replacement combined with CABG 38(17.8%). AKI occurrences differed significantly between the different groups of surgery (p<0.0001). Lengths of stay in ICU were significantly longer (p<0.0001) in AKI group compared with non AKI group: 3(2-4) days versus 2(2-3) days. No difference (p = 0.65) was observed between the two (AKI and NON-AKI) groups in hospital length of stay: 13(10-18) days versus 12(10-16) days. Conclusions: The incidence of AKI is very high in this population as compared to the literature. This may be due to the fact that the three elements of the RIFLE classification for all the population studied have been used: serum creatinine level, urine output and glomerular filtration rate. This study emphasizes the need for clear definition of AKI in order to compare adequately different studies. AKI after cardiac surgery with cardiopulmonary bypass would be further studied in order to develop more appropriate preventive measures. [less ▲]

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See detailMultimodality blood conservation strategy in cardiac surgery with cardiopulmonary bypass : the CHU of Liège experience
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, September 29)

Introduction: The aim of this study is to analyze the transfusion rates of cardiac surgery patients in a single centre following an in-house strategy of blood conservation. Methods: The data of all adult ... [more ▼]

Introduction: The aim of this study is to analyze the transfusion rates of cardiac surgery patients in a single centre following an in-house strategy of blood conservation. Methods: The data of all adult patients undergoing normothermic cardiac surgery with cardiopulmonary bypass (CPB) over a 1 year period were retrospectively collected (n=491). Management protocols were described. The transfusion rates of allogeneic blood components were recorded: red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PT), as well as the number of units transfused. The timing of transfusion was categorized: during CPB (peroperative period), within the first 48 postoperative hours after wean out CPB (early postoperative period) and during the hospitalisation from surgery until discharge (hospitalisation). The hematocrit values were recorded during CPB, 10 minutes after wean out CPB, after the first 48 postoperative hours and at discharge from hospital. Results: Two hundred and forty-eight patients (50%) received an allogeneic blood component transfusion during hospitalisation. One hundred and twenty-one patients (25%) received RBC during the operative period; the median of units transfused was 2(1-2).The lowest hematocrit value during CPB was 21(19-24) % in median. A cell salvage device was used in each case: the median volume of washed red blood cells transfused was 678(512-891) mL. The median hematocrit value after CPB was 23(21-25) %. One hundred and sixty-five patients (34%) were transfused in the early postoperative period: 27% received RBC, 18% received FFP and 18% received PT. The median of units transfused was 2(1-3) for RBC, 4(2-6) for FFP and 1(1-2) for PT. The median hematocrit value after 48 hours was 32(29-34) % and 32(30-35) % at discharge. Conclusion: The transfusion rates observed in this series are relatively high compared with the literature. Improvements will be made in our practice and protocols management in order to decrease the need of transfusion. This detailed audit of the transfusion practices in our cardiac surgery centre would be helpful to value the effectiveness of further improvements. [less ▲]

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See detailPostoperative bleeding and autotransfusion
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Poster (2012, September 29)

Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could ... [more ▼]

Introduction: Bleeding in the postoperative period of cardiac surgery is not infrequent. Mediastinal bleeding is usually collected in a chest drainage system and discarded. Nevertheless, this blood could potentially be managed with a cell salvage device during the first six postoperative hours. This practice is generally performed only in case of a surgical re-exploration for massive bleeding and may contribute to decreased allogeneic transfusion. But in case of postoperative coagulopathy requiring medical treatment, re-exploration is usually postponed and consequently, collected blood is discarded. Therefore, chest drainage systems combined with a cell salvage option could optimize the management of blood losses and transfusions in the postoperative period, regardless of any surgical re-exploration. The aim of this study is to assess the effectiveness of such a system during the postoperative period of cardiac surgery, in patient at high risk of bleeding. Method : During a 6 months period, the CardioPAT® (Haemonetics) device was used in all cardiac surgery patients at high risk of postoperative bleeding. The following data were prospectively collected: hemoglobin level, bleeding volume, volume of autologous washed red blood cell transfused by the CardioPAT® (WRBC), volume of allogeneic red blood cell (RBC), fresh frozen plasma (FFP) or platelets (PT) transfused and surgical re-exploration. Results : The CardioPAT® was used in 16 patients during the target period. Mean postoperative bleeding volume was 338±337mL after 1 hour and 820±727mL after 6 hours. The cell salvage option was used in 9 (56%) cases and mean WRBC transfused volume was 153±212mL. One patient required surgical re-exploration. All patients transfused by WRBC received previously an allogeneic transfusion (RBC, FFP and/or PT). The hemoglobin level of blood collected in the CardioPAT® device impacted on the delay and the blood volume required for WRBC availability; lower was the hemoglobin level, larger was the volume of blood required to obtain a concentrate of WRBC. Consequently, patients with a very low hemoglobin level were anyway transfused with RBC. Conclusion : The CardioPAT® device can reduce allogeneic blood transfusion after cardiac surgery in patients at high risk of bleeding. It gives time to treat coagulopathy, leading to a decrease of surgical re-exploration. However, a device with a larger reservoir and with a flexible processing speed would be more accurate in case of major haemorrhage. Systematic utilisation of this device at the time of FFP and/or PT transfusion is a safe but expensive strategy. It seems more accurate to use this device in a permissive bleeding strategy, waiting for the spontaneous coagulation recovery of the patient, in the first postoperative hours. [less ▲]

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See detailAbout the diagnosis of acute transfusion-related reaction during cardiopulmonary bypass
ERPICUM, Marie ULg; BLAFFART, Francine ULg; DEFRAIGNE, Jean ULg et al

Conference (2012, September 29)

Many advances have been realized in the field of blood safety during the last decade: donors’ selection, leukoreduction of packed red blood cells and platelet concentrates, genomic screening of blood ... [more ▼]

Many advances have been realized in the field of blood safety during the last decade: donors’ selection, leukoreduction of packed red blood cells and platelet concentrates, genomic screening of blood-borne diseases, viral and bacterial inactivation process,... However, transfusion of blood components remains unsafe. Therefore, detecting and reporting transfusion-related complications are still essential means for both the patients’ management and the public health approach, since these measures help to adjust preventive measures to be applied in a haemovigilance purpose. Most acute transfusion-related complications occur within minutes or hours after transfusion and require urgent medical care; delayed transfusion reactions may also develop days, even months later, implying a longer follow-up. Transfusion of red blood cells is not infrequent during cardiac surgery with cardiopulmonary bypass. Symptoms of acute transfusion-related reactions include hypotension, diffuse bleeding, hemoglobinuria and oliguria. These symptoms are identical to those that can be observed during a complicated cardiopulmonary bypass. Consequently, identification of acute transfusion-related reactions in this particular situation is quite difficult and probably leads to an under-reporting of their occurrence. In this paper, we explore how to track acute transfusion-related reactions during cardiopulmonary bypass. Any suspicion of such reactions must leads to investigations, in order to confirm the diagnosis. Their detection would allow to better focus their specific treatment and further their notification in a global blood safety policy. [less ▲]

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See detailCardiac surgery and shed blood management: one way to improve the quality of cardiopulmonary bypass
LAGNY, Marc-Gilbert ULg; BLAFFART, Francine ULg; KOCH, Jean-Noël ULg et al

Diverse speeche and writing (2012)

Présentation réalisée au cours d'un "work-shop" organisé par la société Eurox, implantée à Bruxelles. Au cours de cette présentation, la gestion du sang épanché durant la circulation extra-corporelle a ... [more ▼]

Présentation réalisée au cours d'un "work-shop" organisé par la société Eurox, implantée à Bruxelles. Au cours de cette présentation, la gestion du sang épanché durant la circulation extra-corporelle a été développée ainsi que la présentation d'un projet d'étude clinique en cours au Centre Hospitalier Universitaire de Liège. [less ▲]

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