title: An evaluation of changes in composition and contamination of salvaged blood from the cardiopulmonary bypass circuit of pediatric patients.
abstract: OBJECTIVE
  To review changes that occur during an 18-hour period in composition and bacterial contamination of blood salvaged from the cardiopulmonary bypass (CPB) circuit of pediatric patients.
  
  
  METHODS
  Prospective, blinded study.
  
  
  METHODS
  Pediatric tertiary multidisciplinary intensive care unit.
  
  
  METHODS
  One hundred and one children who underwent CPB.
  
  
  METHODS
  The degree of bacterial contamination and biochemical and hematologic alterations of blood salvaged from the CPB and any increased blood loss associated with reinfusion of this blood.
  
  
  METHODS
  The salvaged blood from the CPB circuit was collected into 1 L blood transfer packs after CPB. This blood was then stored at room temperature for 18 hours. Sampling occurred immediately after CPB and at 6 and 18 hours for biochemic and hematologic assay and for the detection of bacterial organisms. The amount of chest drainage loss was assessed in the first 18 hours after bypass. The type and amount of intravenous fluid infused also was recorded.
  
  
  RESULTS
  Bacterial contamination occurred in three samples (two at 6 hours and in one of the preceding at 18 hours) of the 101 units of salvaged blood. All three positive cultures grew a coagulase-negative staphylococcus. Sodium and potassium remained within normal physiologic values. The glucose values declined from 15.8 to 13.4 mmol/L, and the hemoglobin values increased from 0.4 to 0.5 gm/dl. The reinfusion of the salvaged blood (and any other blood or blood products) to 31 of the 101 patients averaged 14.2 ml/kg/24 hr, with a mean chest drainage loss of 4.9 ml/kg/24 hr. The remaining 70 patients received 12.5 ml/kg/hr of either plasma expanders or blood, with a mean chest drainage loss of 6.0 ml/kg/24 hr.
  
  
  CONCLUSIONS
  The results of this study demonstrate minimal chemical deterioration and limited microbiologic contamination in blood that was salvaged from the CPB circuit and stored at room temperature for an 18-hour period. No increase in postoperative bleeding was noted from the use of this blood. These results suggest it may be safe to reinfuse salvaged blood after CPB in pediatric patients for up to 18 hours; however, a prospective clinical trial is needed to validate these findings.
authors.affiliation: Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Hishon
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.forename: P
authors.initials: P
authors.lastname: Lithgow
authors.forename: W
authors.initials: W
authors.lastname: Butt
mesh_terms: D001769:Blood / Q000382:microbiology*; D001774:Blood Chemical Analysis; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000503:physiopathology; D001793:Blood Preservation; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013210:Staphylococcus / Q000302:isolation & purification