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Dopamine Optimizes Venous Return During Cardiopulmonary Bypass and Reduces the Need for Postoperative Blood Transfusion

Moscarelli, Marco*; Condello, Ignazio*; Fattouch, Khalil; Punjabi, Prakash; Ajello, Valentina§; Solimando, Carlo; Fiore, Flavio; Angelini, Gianni; Speziale, Giuseppe*

doi: 10.1097/MAT.0000000000000930
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Venodilation occurs shortly after the institution of cardiopulmonary bypass (CPB), necessitating fluid or vasoconstrictor administration to maintain adequate oxygen delivery. The vasoconstrictor effects of dopamine are not well studied in this context. Therefore, we conducted a single-center, double-blind case–control study to determine the role and utility of dopamine as a vasoconstrictor during CPB. The study included 60 adults who were scheduled for isolated elective/urgent coronary artery bypass grafting. Patients in group A (n = 30) received a dopamine bolus (2 mg) 20 min after cross-clamping, whereas patients in group B (n = 30) did not receive any intervention at a specific time point. Both groups received standard care as needed (fluid replacement or norepinephrine bolus). Venous return was measured directly in the reservoir and indirectly by Doppler measurement at the level of the inferior vena cava with transesophageal echocardiography. Both open and closed circuits were used for CPB. A single dopamine bolus (2 mg) increased volume in the venous reservoir in group A. Group A patients also received significantly fewer units of red blood cells in the intensive care unit (ICU) than did patients in group B. There were no significant between-group differences in postoperative bleeding, mechanical ventilation, or length of stay in the ICU. These findings suggest that use of a dopamine bolus can increase venous return and reduce the need for fluid replacement during and after CPB in patients undergoing coronary artery bypass grafting.

From the *GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy

GVM Care & Research, Department of Cardiovascular Surgery, Villa Maria Eleonora, Palermo, Italy

Hammersmith Hospital, Imperial College, London, United Kingdom

§Department of Anesthesiology, Tor Vergata University, Rome, Italy

GVM Care & Research, Department of Anesthesia, Anthea Hospital, Bari, Italy

Bristol Royal Infirmary, Bristol, United Kingdom.

Submitted for consideration June 2018; accepted for publication in revised form November 2018.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Marco Moscarelli, GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Via Camillo Rosalba 35/37 70124, Bari, Italy. Email: m.moscarelli@imperial.ac.uk.

Copyright © 2019 by the American Society for Artificial Internal Organs