title: Safety and efficacy of shed mediastinal blood transfusion after cardiac surgery: a multicenter observational study. Multicenter Study of Perioperative Ischemia Research Group.
abstract: OBJECTIVE
  To examine the efficacy and safety of shed mediastinal blood (SMB) transfusion in preventing allogenic red blood cell (RBC) transfusion.
  
  
  METHODS
  An observational clinical study.
  
  
  METHODS
  Twelve US academic medical centers.
  
  
  METHODS
  Six hundred seventeen patients undergoing elective primary coronary artery bypass grafting.
  
  
  METHODS
  Patients were administered SMB transfusion or not, according to institutional and individual practice, without random assignment.
  
  
  RESULTS
  The independent effect of SMB transfusion on postoperative RBC transfusion was examined by multivariable modeling. Potential complications of SMB transfusion, such as bleeding and infection, were examined. Three hundred twelve of the study patients (51%) received postoperative SMB transfusion (mean volume, 554 +/- 359 mL). Patients transfused with SMB had significantly lower volumes of RBC transfusion than those not receiving SMB (0.86 +/- 1.50 v 1.08 +/- 1.65 units; p < 0.05). However, multivariable analysis showed that SMB transfusion was not predictive of postoperative RBC transfusion. Demographic factors (older age, female sex), institution, and postoperative events (greater chest tube drainage, lower hemoglobin level on arrival to the intensive care unit, and use of inotropes) were significant predictors of RBC transfusion. The volume of chest tube drainage on the operative day (707 +/- 392 v 673 +/- 460 mL; p = 0.30), reoperation for hemorrhage (3.1% v2.5%; p = 0.68), and overall frequency of infection (5.8% v 6.6%; p = 0.81) were similar between patients receiving and not receiving SMB, respectively. However, in patients who did not receive allogenic RBC transfusion, there was a significantly greater frequency of wound infection in the SMB group (3.6% v0%; p = 0.02).
  
  
  CONCLUSIONS
  These data suggest that SMB is ineffective as a blood conservation method and may be associated with a greater frequency of wound infection.
authors.affiliation: Department of Anesthesia, Brigham and Womens Hospital, Boston, MA 02115, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Body
authors.forename: J
authors.initials: J
authors.lastname: Birmingham
authors.forename: R
authors.initials: R
authors.lastname: Parks
authors.forename: C
authors.initials: C
authors.lastname: Ley
authors.forename: R
authors.initials: R
authors.lastname: Maddi
authors.forename: S K
authors.initials: SK
authors.lastname: Shernan
authors.forename: L C
authors.initials: LC
authors.lastname: Siegel
authors.forename: E P
authors.initials: EP
authors.lastname: Stover
authors.forename: M N
authors.initials: MN
authors.lastname: D'Ambra
authors.forename: J
authors.initials: J
authors.lastname: Levin
authors.forename: D T
authors.initials: DT
authors.lastname: Mangano
authors.forename: B D
authors.initials: BD
authors.lastname: Spiess
mesh_terms: D000368:Aged; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D013530:Surgical Wound Infection