Table 3 Protocols

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