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Transfusion and risk of acute kidney injury in cardiac surgery

Wednesday, January 21, 2015

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Source

Source Name: British Journal of Anesthesia

Author(s)

K. Karkouti

In this comprehensive article the author describes the potential harmful effects of peri-operative allogeneic transfusions during cardaic surgery employing the CPB circuit. The author also describes potenital risks of low hematocrits during CPB as would be seen when employing Acute Normovolemic Hemodilution technique for blood conservation. Patient conditions that may provide an early warning of "at risk" patients are outlined. Some insights on potential ways of mitigating the complication of renal failure post cardiac surgery are offered, however, the article left me with a few unanswered questions.  Would the use of continuous ultrafiltration during the CPB phase help to remove the neprotoxic PFH?  Shoud use of CVVH post operativly in "at risk" patients be a routine standard? Would it help?  Should any banked RBC transfusion be first washed in an autotransfusion system before infusion and would this be of potential benefit?

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