Retrograde Autologous

Priming of Cardiopulmonary
Bypass Circuit
Transfusion Risks
Major risks: United States
HIV (AIDS): 1:100,000 - 1:250,000
Hepatitis B: 1: 200,000
Hepatitis C: 1: 2,000 - 1:8,000
Acute hemolytic
reaction: 1: 33,000
1: 800,000 = fatal
Allergic reaction: 1: 20,000
Transfusion Risks
Minor risks: United States
Febrile reaction
Graft vs host disease 1: 1,000,000
Delayed hemolytic reaction 1: 10,000
Alloimmunization
Immunosuppression (??)
Transfusion Risks
Religious Risks: Global

5,000,000 - 7,000,000 people worldwide are of
religions that choose to avoid blood
transfusions, even at the risk of death

> 1,000,000 Jehovahs Witnesses in the U.S.

Transfusion Rates in USA
Red blood cells: 2.3 units / patient

Platelets / FFP / Cryo: 2.9 units / patient

Total exposure: 5.2 units / patient
Transfusion Costs in USA
400,000 cardiac surgery procedures / year

Red blood cells = 2.3 U / patient X $220.00
X 400,000 = $202,400,000

Platelets / FFP / Cryo = 2.9 U / patient X $75.00
X 400,000 = $87,000,000

Total costs / year = ~ $300,000,000
Retrograde Autologous Prime
(RAP)
What is RAP: Retrograde Autologous
Prime
RAP involves displacing the pump prime
with the patients own blood, prior to CPB
This causes less hemodilution and,
therefore, a higher hematocrit on bypass


Benefits of RAP
Reduced hemodilution
More physiological viscosity = better BP management
Higher HCT = better O2 transfer / less RBCs used
Higher circulating plasma proteins = less edema
Higher circulating clotting factors = higher platelet counts
and fibrinogen = less bleeding = less platelets used
Higher circulating vasoregulating hormones =better
blood pressure management
Retrograde Autologous Prime
How is RAP performed: 2 Stages
Stage 1: slow withdrawl of blood from aorta
Clamp arterial line between oxygenator and filter
Open clamp distal to arterial filter, open filter purge
Aorta arterial line filter purge line reservoir
Turn arterial pump slowly to move extra prime from
reservoir to an empty bag connected to recirc line
May need phenylephrine or levophed drip

Retrograde Autologous Prime
Stage 2: removal of prime in venous line
Open venous line slowly by controlling with hand clamp
Allow venous blood to push clear prime into reservoir
Clamp venous line before venous blood reaches inlet of
reservoir
Turn arterial pump slowly to move extra prime from
reservoir to collection bag connected to recirc line
Retrograde Autologous Prime
Stage 2: removal of prime in venous line (contd)

Now slowly fill reservoir with blood from venous line
Turn arterial pump slowly to chase remaining clear prime
until blood reaches the collection bag
Retrograde Autologous Prime
Hang removed prime, and use during CPB if
needed
Keep in mind, that vasopressors may need to be
administered at the start of CPB, to stabilize the
patient
Vasopressors commonly used via drip, and
include phenylephrine or leveophed
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Figure 2
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Figure 4