Autotransfusion of washed shed mediastinal fluid decreases the requirement for autologous blood transfusion following cardiac surgery: a prospective randomized trial.
OBJECTIVE
The National Blood Service issues 2.2 million units of blood per year, 10% of these (220000) are utilized in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We test the efficacy of autotransfusion following surgery in a prospective randomized trial.


METHODS
One hundred and twelve patients undergoing CABG, valve or CABG + valve procedures were randomized into two groups. Group A received washed postoperative drainage fluid and group C were controls. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a PCV < 30. There was no significant difference in preoperative and operative variables between the groups.


RESULTS
Twenty-eight patients in group A and 46 in group C required homologous transfusion (P = 0.0008). Group A patients required 298+/-49 ml of banked blood per patient, group C 508+/-49 ml (P = 0.003). There was no difference in total blood required (volume autotransfused + volume banked blood transfused) between the groups (group A 404+/-50 ml, group C 508+/-50 ml) or in mean total mediastinal fluid drainage (group A 652+/-51 ml, group C 686+/-50ml). The mean Hb concentration was significantly higher in group A on day 1 (11.2 g/dl+/-51 vs. 10.6 g/dl+/-13 (P = 0.002)). No morbidity was associated with autotransfusion.


CONCLUSIONS
Autotransfusion can decrease the amount of homologous blood transfused following cardiac surgery. This represents a benefit to the patient and a decrease in cost to the health service.
Dalrymple-Hay
M J
MJ
Wessex Cardiothoracic Centre, Department of Cardiothoracic Surgery, Southampton General Hospital, UK. mdh@btinternet.com
Pack
L
L
Deakin
C D
CD
Shephard
S
S
Ohri
S K
SK
Haw
M P
MP
Livesey
S A
SA
Monro
J L
JL
D000368:Aged; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000379:methods*; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D004322:Drainage; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008482:Mediastinum; D011183:Postoperative Complications; D011446:Prospective Studies
D006454:Hemoglobins