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Modified Ultrafiltration in Adults: Should We All Be Doing It?

Modified Ultrafiltration in Adults: Should We All Be Doing It?. Kenneth G. Shann, CCP Assistant Director, Perfusion Services Senior Advisor, Performance Improvement Montefiore Medical Center New York, NY. Disclosure. No Relationships to Disclose. Outline. Describe the technique of MUF

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Modified Ultrafiltration in Adults: Should We All Be Doing It?

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  1. Modified Ultrafiltration in Adults: Should We All Be Doing It? Kenneth G. Shann, CCP Assistant Director, Perfusion Services Senior Advisor, Performance Improvement Montefiore Medical Center New York, NY

  2. Disclosure No Relationships to Disclose

  3. Outline • Describe the technique of MUF • Discuss the recent guideline recommendation and supporting literature regarding MUF in adults • Discuss the logistical challenges related to the MUF technique

  4. Modified Ultrafiltration (MUF) • Performed after CPB before protamine • Blood is drained from the venous line into the reservoir • Using the cardioplegia pump, blood is pumped out of the aorta and retrograde down the arterial line • Blood passes through the hemoconcentratorand heat exchanger and back to right atrium

  5. MUF Ann ThoracSurg 1994;58:573-4

  6. Modified Ultrafiltration (MUF) • 10 – 15 mL/kg/min up to 500mL/min • Performed for 10 to 20 minutes • Volume status of patient is monitored closely • Volume removed through ultrafiltration is replaced with volume from CPB circuit • When venous reservoir is empty blood is chased with crystalloid • Substances with molecular weight < 65,000 daltons are removed

  7. Transfusion Guidelines Ann ThoracSurg 2007;83:S27– 86

  8. Transfusion Guidelines Ann ThoracSurg 2011;91:944–82

  9. Supporting Literature European Journal of Cardio-thoracic Surgery 30 (2006) 892—897

  10. Supporting Literature Circulation. 2001;104[suppl I]:I-253-I-259

  11. Supporting Literature Circulation. 2001;104[suppl I]:I-253-I-259

  12. Supporting Literature J Ayub Med CollAbbottabad 2007;19(4)

  13. Supporting Literature J ThoracCardiovascSurg 2011;141:1298-304

  14. Logistical Challenges of MUF • Cannulation for adult procedures • Modifications to CPB circuit • Associated risks – air embolism, hypothermia, hypotension • Increased cost? • Time commitment (10 – 20 minutes after CPB)

  15. Conclusions • Peer-reviewed literature supports the use of MUF in adult patients • Recent STS/SCA/ICEBP Transfusion Guidelines recommend the use of MUF in adult patients to conserve blood transfusion and reduce bleeding • Despite supporting literature, routine use of MUF in adult patients is uncommon • Where do we go from here?

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