Preparation of a cardiopulmonary bypass priming solution for infants and neonates – effect of pre-bypass ultrafiltration on heparinization
Bibliographic record
Abstract
IntroductionHeparin is usually added to infant cardiopulmonary bypass circuit primes. Ultrafiltration is often used to minimise prime volume before commencing bypass. The extent of heparin removal from bypass primes by ultrafiltration is unknown, however at our institution it was assumed that heparin is freely filtered. The primary aim of this study was to investigate heparin removal during pre-bypass ultrafiltration of a bypass prime for infants. The secondary aim was to investigate the effect of pre-bypass ultrafiltration on heparinization of the patient shortly after commencing bypass.MethodsPatients under 1 year of age having cardiopulmonary bypass were enrolled. Prime solutions contained red blood cells, albumin, PlasmaLyte and 3 IU/ml heparin prior to pre-bypass ultrafiltration. Patient blood samples were collected before and after commencing bypass along with samples of the filtrate and the priming solution. Anti-Xa and antithrombin levels were measured by chromogenic assay.ResultsNineteen patients were enrolled. Patient weight ranged from 2.4 kg to 7.7 kg. Anti-Xa in the filtrate was 0.94 IU/ml (IQR 0.84 to 1.06 IU/ml). Anti-Xa in the primes was 6.80 IU/ml (IQR 6.68 to 7.84 IU/ml). Anti-Xa once on bypass was 3.31 IU/ml (IQR 2.08 to 4.46 IU/ml). Antithrombin level on bypass was 38 % (IQR 26 to 57 %). On bypass anti-Xa level was associated with patient weight and antithrombin level but not with activated clotting time.ConclusionsHeparin is not freely filtered from the prime, leading to more heparin being present in the prime than desired. Anti-Xa levels on commencing bypass appear to be predictably influenced by hemodilution such that the gap between total heparin present and anti-Xa activity is wider in smaller patients. The activated clotting time does not differentiate lower levels of anti-Xa activity in the setting of extreme haemodilution.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".