Authors
1
Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.
2
Department of Anesthesiology, Sadoughi University of Medical Sciences, Yazd, I.R. I.R. Iran
3
Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran
4
Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.
5
Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran
6
Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I.R. Ira
Abstract
Background: All intraoperative strategies that may assist an anesthesiologist with lowering the
blood transfusion rate must be considered. We assessed the efficacy of the 30° head-up
position at the end of cardiopulmonary bypass (CPB) in returning CPB reservoir blood to
patients, reducing the transfusion rate, and conferring hemodynamic stability after the
transfer of patients to the intensive care unit (ICU).
Methods: In a single-center clinical trial, 88 adult patients undergoing elective isolated coronary
artery bypass graft surgery were randomly allocated to the head-up group (n=44), in which
the 30° head-up position was applied during separation from CPB, and the supine group
(n=44), in which weaning from CPB was performed in the supine position. All the patients
had left ventricular ejection fractions > 35%. The primary end point was the returned
volume of filtered CPB blood to the patients. The secondary outcome measures were
intraoperative and early postoperative hemodynamic parameters. Additionally, blood
products transfused during surgery and in the 1st 6 hours following ICU admission were
recorded.
Results: There were no statistically significant differences in intraoperative and early postoperative
hemodynamics between the 2 groups except in the returned blood volume to the patients
after separation from CPB (714 ± 99 mL in the head-up position group vs 285 ± 78 mL in
the supine group; P = 0.0001). There were no significant differences between the 2 groups
regarding the transfused blood products during surgery and the 1st 6 hours following ICU
admission.
Conclusions: Using the 30° head-up position at the end of CPB conferred a higher return of blood
to the patients but did not significantly reduce postoperative transfusion.
Keywords
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