The role of acute normovolemic hemodilution and retrograde autologous priming in reducing intraoperative packed red blood cell transfusion needs in coronary artery bypass surgery: A randomized controlled trial.
Cindy Elfira Boom, Riza Cintyandy, Hery Widodo et al.
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In 30 seconds
This single-center randomized controlled trial compared acute normovolemic hemodilution (ANH) plus retrograde autologous priming (RAP) with RAP alone in 72 patients undergoing coronary artery bypass grafting. Intraoperative packed red blood cell transfusion was less frequent with combined ANH and RAP (19.4% vs 47.2%, p = 0.024), and patients received fewer allogeneic units (0.2 ± 0.4 vs 0.5 ± 0.6, p = 0.012). Postoperative outcomes did not differ between groups. The findings support a reduction in intraoperative transfusion with the combined blood-conservation approach in this study population.
Key findings
- Intraoperative transfusion rates were 19.4% with ANH plus RAP and 47.2% with RAP alone (p = 0.024).
- Mean intraoperative allogeneic PRBC units were 0.2 ± 0.4 versus 0.5 ± 0.6, respectively (p = 0.012).
- Postoperative outcomes did not differ between the randomized groups.
- The reported optimal ANH volume for reducing intraoperative allogeneic PRBC transfusion was 380 mL (ROC area 0.862, 95% CI 0.703-1.000, p = 0.003).
Why it matters
Avoiding allogeneic transfusion is a relevant goal in cardiac surgery, where blood-conservation strategies may reduce exposure to donor blood. This trial provides randomized evidence that adding ANH to RAP can lower intraoperative transfusion use in CABG patients, while reporting no difference in postoperative outcomes. The result may inform evaluation of combined conservation protocols, although it comes from a single center.
What to keep in mind
The trial was single-center and included 72 patients; the abstract does not report longer-term outcomes.