The inflammatory response to recycled pericardial suction blood and the influence of cell-saving.
OBJECTIVE
To investigate the inflammatory and cellular response attributed to conventional cardiotomy suction vs cell-saver during cardiac surgery.


METHODS
Thirty-three (n = 33) low-risk patients admitted for routine coronary artery bypass grafting were randomly assigned to two groups: cardiotomy suction or cell-saver for salvage of pericardial blood. The groups were compared with reference to proinflammatory cytokines, complement activation, leukocyte pattern, and haemolysis during and after cardiopulmonary bypass.


RESULTS
Pericardial suction blood contained significantly increased concentrations of free plasma haemoglobin, C3a, IL-6, IL-8, TNF-alpha, eosinophils and basophils compared with the systemic circulation. No differences were found for the terminal complement complex and lymphocytes, whereas overall concentrations of leukocytes, platelets and haemoglobin were decreased. Recycling of pericardial suction blood gave no systemic effects except from that of free plasma haemoglobin, which increased significantly. The cell-saver eliminated plasma haemoglobin, but no other effects could be demonstrated.


CONCLUSIONS
Cardiotomy suction is a major cause of haemolysis, but contributes insignificantly to the systemic inflammatory response. Treatment of shed mediastinal blood with a cell-saver reduces haemolysis and may lower the dose load of inflammatory components.
Svenmarker
Staffan
S
Department of Surgical and Perioperative Science, Umeå University Hospital, Sweden.
Engström
Karl Gunnar
KG
D000704:Analysis of Variance; D001781:Blood Component Removal; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D016207:Cytokines / Q000032:analysis / Q000097:blood*; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011300:Preoperative Care; D011336:Probability; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D016207:Cytokines; D018836:Inflammation Mediators