Effects of Prime Solutions Used in Cardiopulmonary Bypass on Organ Functions

Abstract

Cardiopulmonary bypass (CPB) is a widely used technique in cardiac surgery, and the priming solutions employed during this process play a critical role in filling the circuit, maintaining hemodynamic balance, preserving electrolyte and fluid homeostasis, and optimizing organ perfusion. The composition of priming solutions including crystalloids or colloids, blood-based solutions, and added agents such as mannitol or albumin can directly influence hemodynamic responses, inflammatory processes, and organ function. Evidence suggests that priming strategies may significantly affect renal, neurological, pulmonary, and cardiac functions. Specifically, studies on renal function indicate that priming solutions can influence the risk of acute kidney injury (AKI). Neurological outcomes are also affected by the degree of hemodilution and the composition of the priming solution, potentially contributing to postoperative cognitive changes. Variations in priming composition have been observed to impact pulmonary and cardiac parameters, with strategies such as albumin supplementation potentially improving fluid balance and reducing postoperative complications. On the other hand, the renoprotective effects of agents like mannitol remain limited and inconsistent, while blood-based priming may enhance inflammatory responses. Studies evaluating the long-term effects of priming solutions on organ function are scarce. Most research has focused on short- to medium-term outcomes, with limited randomized controlled data on long-term results. Consequently, understanding the long-term clinical implications of different priming strategies remains challenging. The purpose of this review is to examine the effects of priming solutions used during cardiopulmonary bypass on organ function and to provide a comprehensive overview of the topic.