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Hemodilution on microvascular oxygen delivery potential of the blood during coronary bypass surgery

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Abstract

Purpose

The hematocrit-to-whole blood viscosity ratio (Hct/WBV) reflects the blood O2 delivery potential (O2-DP). WBV is variable to the dynamic vascular shear rate (SR), 1–5/s at microcirculation and 300/s at larger vessels. To estimate the impact of hemodilution on the blood O2-DP to the myocardium, we analyzed the hemodilution-induced change of Hct/WBV at SR 5/s (Hct/WBV5) during off-pump coronary bypass (OPCAB) surgery.

Methods

During OPCAB surgery (n = 21), 10% acute normovolemic hemodilution (HD 10%) was applied. Arterial blood samples were taken: one before and two after HD 10%. One of which after HD 10% underwent an additional 33% in vitro hemodilution (reaching 40% hemodilution in total, HD 40%). WBV of all blood samples was determined using a scan-capillary tube viscometer (Hemovister™). The changes of Hct/WBV5 were analyzed as a primary measure of the study and compared with those of Hct/WBV at SR 300/s (Hct/WBV300).

Results

Median[IQR] of Hct/WBV5 [3.5 (2.8–4.2)%/cPoise] was significantly increased by HD 10 and HD 40% [3.6 (3.2–4.6)%/cPoise and 4.2 (3.3–5.2)%/cPoise, respectively, all P < 0.001], but the degrees of changes after HD 10 and HD 40% were not different. Median[IQR] of Hct/WBV300 [10.3(8.6‒10.8)%/cPoise] was not changed by HD 10% [10.3(9.1–11.1)%/cPoise], but it was significantly decreased by HD 40% [8.4(7.4‒9.2)%/cPoise, P < 0.001].

Conclusion

The increased Hct/WBV5 suggests that 10–40% hemodilution improves the blood O2-DP to the myocardium during OPCAB surgery. The SR-specific discrepancy in Hct/WBV changes advocates using microvascular WBV and Hct/WBV to evaluate the blood O2-DP changes to the myocardium. Further study is warranted to assess the actual changes in myocardial O2 delivery.

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Acknowledgements

We want to thank Editage (http://www.editage.co.kr) for editing and reviewing this manuscript for the English language. There was a considerable delay from recruiting the last patient to submitting the current manuscript due to the restricted research-related activity and institutional policy during the prolonged COVID pandemic.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea

    Dong-Kyu Lee

  2. Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

    Sarah Park

  3. Institute of Anesthesiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland

    Donat Rudolf Spahn

  4. Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea

    Tae-Yop Kim

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  1. Dong-Kyu Lee
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Lee, DK., Park, S., Spahn, D.R. et al. Hemodilution on microvascular oxygen delivery potential of the blood during coronary bypass surgery. J Anesth 36, 723–730 (2022). https://doi.org/10.1007/s00540-022-03109-9

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