Additional postoperative cell salvage of shed mediastinal blood in cardiac surgery does not reduce allogeneic blood transfusions: a cohort study

Abstract

Objectives:

Does additional postoperative collection and processing of mediastinal shed blood with a cell salvage device reduce the number of allogeneic blood transfusions compared to intraoperative cell salvage alone?

Methods:

A single-centre cohort study in which adult patients with coronary artery bypass grafting or aortic valve replacement were allocated to either a C.A.T.S^® group with intraoperative blood processing only or a CardioPat^® group with both intra- and postoperative blood processing. The primary endpoint was the number of allogeneic blood transfusions during hospital admission.

Results:

The study included 99 patients; 50 in the C.A.T.S^® and 49 in the CardioPat^® group.

There was no difference in the number of red blood cells (RBC) (C.A.T.S^® group 43 units versus CardioPat^® 50 units, p=0.74), fresh frozen plasma (C.A.T.S^® 8 units versus CardioPat^® 8 units, p=1.00) or platelets (C.A.T.S^® 5 units versus CardioPat^® 4 units, p=1.00) transfused during the hospital stay.

Cardiac creatinine kinase (CK-MB) and troponin levels did not differ between the groups although a significant time effect (p<0.001) was present. Creatinine kinase (CK) levels were not different between the groups three hours after arrival in the intensive care unit (ICU) (CardioPat^® group versus C.A.T.S^® group, p=0.17). But, compared to the C.A.T.S^® group on the first (350 [232-469] IU/L) and second postoperative days (325 [201-480] IU/L), the increase in CK levels was more in the CardioPat^® group on the first (431 [286-642] IU/L, p=0.02) and second postoperative days (406 [239-760] IU/L, p=0.05), resulting in a difference between the groups (p=0.04)

Conclusions:

Postoperative cell salvage does not reduce transfusion requirements compared to intraoperative cell salvage alone, but results in elevated total CK levels that suggest haemolysis.

Keywords

auto transfusion cell salvage blood transfusion haemolysis

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References

Wang

Bainbridge

Martin

Cheng

. The efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials. Anesth Analg 2009; 109: 320–330.

Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris

Brown

Despotis

. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91: 944–982.

Marberg

Jeppsson

Brandrup-Wognsen

. Postoperative autotransfusion of mediastinal shed blood does not influence haemostasis after elective coronary artery bypass grafting. Eur J Cardiothorac Surg 2010; 38: 767–772.

Folkersen

Tang

Grunnet

Jakobsen

. Transfusion of shed mediastinal blood reduces the use of allogenic blood transfusion without increasing complications. Perfusion 2011; 26: 145–150.

Lau

Shah

Kelleher

Moat

. Coronary artery surgery: cardiotomy suction or cell salvage? J Cardiothorac Surg 2007; 2: 46.

Dalrymple-Hay

Pack

Deakin

. Autotransfusion of washed shed mediastinal fluid decreases the requirement for autologous blood transfusion following cardiac surgery: a prospective randomized trial. Eur J Cardiothorac Surg 1999; 15: 830–834.

Klein

Nashef

Sharples

. A randomized controlled trial of cell salvage in routine cardiac surgery. Anesth Analg 2008; 107: 1487–1495.

Murphy

Allen

Unsworth-White

Lewis

Dalrymple-Hay

. Safety and efficacy of perioperative cell salvage and autotransfusion after coronary artery bypass grafting: a randomized trial. Ann Thorac Surg 2004; 77: 1553–1559.

Sirvinskas

Veikutiene

Benetis

. Influence of early re-infusion of autologous shed mediastinal blood on clinical outcome after cardiac surgery. Perfusion 2007; 22: 345–352.

10.

Weltert

Nardella

Rondinelli

Pierelli

De Paulis

. Reduction of allogeneic red blood cell usage during cardiac surgery by an integrated intra- and postoperative blood salvage strategy: results of a randomized comparison. Transfusion 2013; 53: 790–797.

11.

Vermeijden

van Klarenbosch

. Effects of cell-saving devices and filters on transfusion in cardiac surgery: a multicenter randomized study. Ann Thorac Surg 2015; 99: 26–32.

12.

American Association of Blood Banks. Standards for perioperative autologous blood collection and administration. 2013.

13.

Mehta

Kellum

Shah

. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

14.

Westerberg

Bengtsson

Jeppsson

. Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response. Ann Thorac Surg 2004; 78: 54–59.

15.

Wahl

Feins

Alfieres

Bixby

. Reinfusion of shed blood after coronary operation causes elevation of cardiac enzyme levels. Ann Thorac Surg 1992; 53: 625–627.

16.

Pleym

Tjomsland

Asberg

. Effects of autotransfusion of mediastinal shed blood on biochemical markers of myocardial damage in coronary surgery. Acta Anaesthesiol Scand 2005; 49: 1248–1254.

17.

Vertrees

Conti

Lick

Zwischenberger

McDaniel

Shulman

. Adverse effects of postoperative infusion of shed mediastinal blood. Ann Thorac Surg 1996; 62: 717–723.

18.

Gabel

Westerberg

Bengtsson

Jeppsson

. Cell salvage of cardiotomy suction blood improves the balance between pro- and anti-inflammatory cytokines after cardiac surgery. Eur J Cardiothorac Surg 2013; 44: 506–511.

19.

Vermeijden

Hagenaars

van Oeveren

de Vries

. Do repeated runs of a cell saver device increase the pro-inflammatory properties of washed blood? Eur J Cardiothorac Surg 2008; 34: 350–353.