Key result
Central vein access for double-filtration plasmapheresis resulted in significantly lower systolic blood pressure at 60 minutes compared to peripheral vein access (93.1% vs. 101.0%, P<0.05).
Why the study?
Does central vein access compared to peripheral vein access affect blood pressure and pulse rate during double filtration plasmapheresis in myasthenia gravis patients?
RCT (n=46)
randomized
Does central vein access compared to peripheral vein access affect blood pressure and pulse rate during double filtration plasmapheresis in myasthenia gravis patients?
Absolute Event Rate: 93.1% vs 101%
p-value: p=<0.05
Central vein access during double filtration plasmapheresis causes a greater transient drop in systolic blood pressure compared to peripheral access, suggesting flow rates should be controlled to prevent hypotension.
Central access heightens hypotension risk during plasmapheresis; warrants flow-rate control and extends access-site safety data in myasthenia gravis.
Systematic investigations of hemodynamic status during double filtration plasmapheresis (DFP) are rare in the literature. To investigate the hemodynamic effects of the vascular access chosen for DFP, variations in blood pressure (BP) and pulse rate (PR) induced acutely by DFP were prospectively analyzed in 46 myasthenia gravis (MG) patients a standard DFP protocol with isovolumetric saline fluid replacement. BP and PR were monitored at 30-min intervals (baseline, M30, M60, M90, and M120) during the procedures. The patients were randomized into central vein (CV) and peripheral vein (PV) groups based on the vascular access used. Systolic BP (SBP) dropped significantly at M60 (P < 0.05), M90 (P < 0.001), and M120 (P < 0.001) when compared to the baseline level. Symptomatic hypotension was not observed in any of the 46 sessions. SBP values during DFP in the CV group were significantly lower than the PV group's at M60 (93.1 vs. 101.0%, P < 0.05) and marginally lower at M90 (91.2 vs. 97.2%, P = 0.06). There was no significant difference in diastolic BP changes between the two groups. In the CV and PV groups, PR changes during plasmapheresis also differed at M90 (103.4 vs. 94.5%, P < 0.001) and M120 (101.3 vs. 95.0%, P < 0.05). The significantly lower SBP during DFP in the CV group at M60 may be due to the high central vein flow rate and resultant delay in volume replacement. In conclusion, the vascular access selected for DFP plays a role in the pathogenesis of plasmapheresis-related hypotension. Controlling flow rates may help to prevent hypotension.
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Yeh et al. (2001) conducted an RCT in myasthenia gravis (n=46). Central vein access vs. Peripheral vein access was evaluated on Systolic blood pressure at 60 minutes (percentage of baseline) (p=<0.05). Central vein access for double-filtration plasmapheresis resulted in significantly lower systolic blood pressure at 60 minutes compared to peripheral vein access (93.1% vs. 101.0%, P<0.05).
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