Retrograde Autologous Priming (Question for Perfusionist)

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Polishblood

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I have a question regarding retrograde autologous priming. I understand the benefit of it. Less hemodilution which means higher HCT, better O2 delivery, more normalize oncotic pressure, etc.

However, I do not understand how you can physically take out, for example, 500ml of blood from the patient, to partially prime your CPB circuit, withhold 500ml of prime, and not expect 500ml less in your reservoir after initiation of bypass. Wouldn't your level in the reservoir be too low? The only way I see this being possible is with systemic vasoconstriction to lower the patient's intravascular volume (which doesn't sound particularly ideal).

Why not remove, for example, 500ml of prime right after priming your CPB machine (w/ the AV loop still intact)? What is the benefit of having the patient hooked up and then removing 500ml of prime (w/ the patient's blood filling the CPB circuit)? From my understanding, removing 500ml of prime with the patient not hooked up VS removing 500ml of prime with the patient hooked up, would have the same effect. Same amount of reduced hemodilution.

Thank you for reading. Looking forward to hearing on-topic responses.