title: Hemodynamic effects of cardiotomy suction blood.
abstract: OBJECTIVE
  Cardiac surgery induces a systemic inflammatory activation, which in severe cases is associated with peripheral vasodilation and hypotension. Cardiotomy suction blood contains high levels of inflammatory mediators, but the effect of cardiotomy suction blood on the vasculture is unknown. We investigated the effect of cardiotomy suction blood on systemic vascular resistance in vivo and whether cell-saver processing of suction blood affects the vascular response.
  
  
  METHODS
  Twenty-five patients undergoing coronary surgery (mean age, 68 +/- 2 years; 80% men) were included in a prospective randomized study. The patients were randomized to retransfusion of cell-saver processed (n = 13) or cell-saver unprocessed (n = 12) suction blood during full cardiopulmonary bypass. Mean arterial blood pressure was continuously registered during retransfusion, and systemic vascular resistance was calculated. Plasma concentrations of tumor necrosis factor alpha, interleukin 6, and complement factor C3a were measured in suction blood.
  
  
  RESULTS
  Retransfusion of cardiotomy suction blood induced a transient reduction in systemic vascular resistance in all patients. The peak reduction was significantly less pronounced in the group receiving cell-saver processed blood (-12% +/- 2% vs -28% +/- 3%, P = .001). There was a significant correlation between tumor necrosis factor alpha concentration in retransfused cardiotomy suction blood and peak reduction of systemic vascular resistance (r = 0.60, P = .002).
  
  
  CONCLUSIONS
  The results suggest cardiotomy suction blood is vasoactive and might influence vascular resistance and blood pressure during cardiac surgery. The observed vasodilation is proportional to the inflammatory activation of suction blood and can be reduced by processing suction blood with a cell-saving device before retransfusion.
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Westerberg
authors.forename: Jakob
authors.initials: J
authors.lastname: Gäbel
authors.forename: Anders
authors.initials: A
authors.lastname: Bengtsson
authors.forename: Johan
authors.initials: J
authors.lastname: Sellgren
authors.forename: Ola
authors.initials: O
authors.lastname: Eidem
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
mesh_terms: D000368:Aged; D001769:Blood / Q000276:immunology*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D011446:Prospective Studies; D013396:Suction; D014664:Vasodilation