Principles of Miniaturized ExtraCorporeal Circulation by Kyriakos Anastasiadis Polychronis Antonitsis & Helena Argiriadou

Author:Kyriakos Anastasiadis, Polychronis Antonitsis & Helena Argiriadou
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

The Fluid Management

Large priming volumes required in standard CPB can result in significant haemodilution with low postoperative haemoglobin concentration and haematocrit. When MECC is used, the haemodilution is much less pronounced due to less priming volume. Initial priming volume of the MECC Maquet system consisted of 500 ml of a balanced crystalloid/colloid solution (250 ml of hydroxyethyl starch 6 %, 200 ml of Ringer’s Lactate solution and 50 ml of mannitol 20 %) [36]. Reduced haemodilution is partially responsible for the observed reduction in the requirement for blood products. Additionally, MECC lacks venous reservoir and cardiotomy suction. This further minimizes haemodilution and mechanical blood trauma. However, because the patient is literally ‘the venous reservoir’ for the system, tight control of vascular tone remains important. The effect of minimal haemodilution may be obviated if excessive crystalloid volume infusion is administered before and during the case. Volume management is challenging in MECC. Intraoperative positioning of the patient (legs up and down) or application of a vasoconstrictor could be considered before volume administ­ration. In case of hypotension observed prior to initiation of MECC, any cause of it (deep ­anaesthesia level, decreased venous return, impaired ­myocardial contractility, ischemia, dysrhythmia, decrease in systemic vascular resistance) has to be ruled out before volume infusion. After all these parameters including PCWP and CVP pressures have been checked, a fluid challenge of 100–300 ml may be given, and the response to it has to be closely monitored.

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