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 • Discuss the recent guideline recommendation and supporting literature regarding MUF in adults • Discuss the logistical challenges related to the MUF technique 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 hemoconcentrator and heat exchanger and back to right atrium MUF Ann Thorac Surg 1994;58:573-4 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 Transfusion Guidelines Ann Thorac Surg 2007;83:S27– 86 Transfusion Guidelines Ann Thorac Surg 2011;91:944– 82 Supporting Literature European Journal of Cardio-thoracic Surgery 30 (2006) 892—897 Supporting Literature Circulation. 2001;104[suppl I]:I-253-I-259 Supporting Literature Circulation. 2001;104[suppl I]:I-253-I-259 Supporting Literature J Ayub Med Coll Abbottabad 2007;19(4) Supporting Literature J Thorac Cardiovasc Surg 2011;141:1298-304 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) 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?