Clinical perfusion data on 16 cases of cardiopulmonary bypass using Sigmamotor pump and Rygg-Kyvsgaard Oxygenator which performed at Seoul National University Hospital during the period of Aug. 1963 to Aug. 1970 was analized. All cases were hemodiluted and the perfusion was carried out under the normothermic condition.
Tie age of the patients ranged between 6 and 43 years. The body weight varied between 18.3 and 54.0 kg and the body surface area between 0.78 and 1. 59M2.
j To priming solution was consisted with fresh ACD blood, Hartmann solution and Mannitol. The average
i amount of priming was approximately 2242 ml. The average hemodilution rate was 17%.
The flow rate ranged from 1.7L to 3.5L/Min/M1 and averaged 2.4L/Min/Ml or 78ml/Min/kg. The duration of perfusion varied from 22 to 110 min with average of 56.9 minutes.
Some hemodynamic responses were observed. The arterial pressure dropped immediately after the initiation of partial perfusion and was more marked after the total perfusion followed by gradual increase to the safety level. The central venous pressure reflected the reduced blood volume especially in the cases of prolonged perfusion which lasted over 60 min.
In most of the cases, red blood cell count decreased and white blood cell count increased after the perfusion.
Hemoglobin level was decreased, averaging of 12.5mg%, Hct 3.3% and platelets count of 18% post-
operatively. Plasma hemoglobin increased mildly, from pre-perfusion average value of 4.06mg% to post-] perfusion value of 22.5mg%. Serum potassium was 4.4mEq/L pre-operatively and was decreased to
3.7mEq/L post-operatively. Five cases showed definite hypopotassemia immediately after the operation. Sodium and chloride decreased mildly. These electrolyte changes are thought to be related with hemodilution, diuretics and reduced blood volume during and after the perfusion.
Arterial blood pH value revealed minimal to moderate elevation from preperfusion average value of 7.376 to 7.461 during perfusion and then 7.365 after perfusion.
The pCO2 and bicarbonate showed minimal to moderately lowered values. The total CO2 was decreased. Buffer base decreased during perfusion (Av. 42.6mEq/L) and further decreased after the perfusion (Av. 40.8mEg1L). These arterial blood acid base changes suggested that the metabolic acidosis was accompanied by respiratory alkalosis during and immediately after the perfusion.
Authors belivel that the acidosis could more effectively be corrected with the more additional dose of bicarbonate than we used by this study.
The chest tube drainage during the first 24 hours following operation was 1158 ml in average. One case (Case No. 15) showed definite bleeding tendency and it was believed that the cause might be due to the defect of heparin and protamine titration.
The average urinary out put during 24 hours post-perfusion was 1291ml. One case (Case No. 1) showed definite post perfusion oliguria.
As conclusion, hemodilution using fresh ACD blood, Hartmann and Mannitol solution added with Bivon and high flow rate unler normothermia, was thought to ameliorate the severity of metabolic acidosis during and after perfusion with relatively satisfactory effect on the diuresis and bleeding tendency.
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