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Table 3 Protocols

From: Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year Experience

1). Protocol for blood conservation a) Preoperative
EPO if hemoglobin levels are <14 g/l
Iron in all cases
Limit the removal of blood in frequency and quantity (use pediatric tubes)
Aprotinin (Hammersmith half-protocol)
Avoid hematomas following angiography and PCI.
b) Perioperative
Retropriming
Short CPB circuit. Heparinization 3 mg/kg body weight reversed by equivalent dose of protamine IV
CPB conducted in normothermia (minimal temperature drift 36 °C)
Warm cardioplegia
Cell Saver
Minimally invasive surgical techniques
Meticulous closure
c) Post operative
Reduce blood retrieval in frequency and quantity (use pediatric tubes)
Reoperate if blood loss continues at 100 cc for three hrs, or immediately if > 200 cc in one hour.
EPO if hematocrit < 24% at time of reoperation
2). Protocol of Aprotonin Administration (Hammersmith Half-Protocol) until its withdrawal in 2007 , then aminocaproic acid is used in all cases 1 million KIU (140 mg) IV at induction of anesthesia, 1 million KIU (140 mg) at completion of CPB and 250,000 KIU (35 mg) IV per hour until skin closure or until a maximum dose of 1 million KIU.
3). Protocol of Erythropoietin Administration 300 UI/Kg IV + 500 UI/Kg subcutaneously on admission followed by 500 UI/Kg subcutaneously every second day.
+ Iron 325 mg PO 3 times a day
4). Retropriming Avoid hemodilution during priming of CPB by passive drainage of blood from venous system
5). MiniCPB CPB using centrifugal pump with small volume , in a closed circuit