The effect of acute normovolaemic haemodilution on the inflammatory response and clinical outcome in abdominal aortic aneurysm repair--results of a pilot trial.
OBJECTIVE
To determine the effect of acute normovolaemic haemodilution (ANH) on the inflammatory response and clinical outcome in elective open abdominal aortic aneurysm (AAA) repair.


METHODS
Randomised controlled clinical trial.


METHODS
Thirty-six patients were randomised to undergo ANH or act as controls. Cell salvage was permitted in both groups. Heterologous blood was transfused according to pre-determined triggers. Outcome measures were markers of the systemic inflammatory response in serum and urine observed at multiple time points, and clinical recovery.


RESULTS
Median 890 (range 670-1620) ml of blood was removed at ANH in 16 patients. There were no differences in peri-operative changes in neutrophil count ( P = 0.13), serum C-reactive protein ( P = 0.38), interleukin-6 ( P = 0.50), total antioxidant capacity ( P = 0.73), urinary secretion of albumin ( P = 0.97) or retinol binding protein ( P = 0.41). There were no differences in the mortality and morbidity rates, systemic inflammatory response syndrome, ITU or hospital stay.


CONCLUSIONS
ANH, when used in combination with cell salvage, made no impact on systemic inflammatory response and clinical outcome when compared to cell salvage alone after AAA repair. ANH cannot be recommended for routine use in patients undergoing abdominal aortic aneurysm surgery when cell salvage is available.
Wolowczyk
L
L
Vascular Unit, University Department of surgery, Bristol Royal Infirmary, Bristol, UK. leszekkolowczyk@hotmail.com
Nevin
M
M
Day
A
A
Smith
F C T
FC
Baird
R N
RN
Lamont
P M
PM
D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000378:metabolism*; D000975:Antioxidants / Q000378:metabolism; D017544:Aortic Aneurysm, Abdominal / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D019917:Blood Vessel Prosthesis Implantation; D002097:C-Reactive Protein / Q000378:metabolism*; D003404:Creatinine / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000652:urine; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D012177:Retinol-Binding Proteins / Q000652:urine*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000975:Antioxidants; D015415:Biomarkers; D015850:Interleukin-6; D012177:Retinol-Binding Proteins; D002097:C-Reactive Protein; D003404:Creatinine