title: Continuous-flow cell saver reduces cognitive decline in elderly patients after coronary bypass surgery.
abstract: BACKGROUND
  Cerebral microembolization during cardiopulmonary bypass may lead to cognitive decline after cardiac surgery. Transfusion of the unprocessed shed blood (major source of lipid microparticulates) into the patient during cardiopulmonary bypass is common practice to reduce blood loss and blood transfusion. Processing of shed blood with cell saver before transfusion may limit cerebral microembolization and reduce cognitive decline after surgery.
  
  
  RESULTS
  A total of 226 elderly patients were randomly allocated to either cell saver or control groups. Anesthesia and surgical management were standardized. Epiaortic scanning of the proximal thoracic aorta was performed in all patients. Transcranial Doppler was used to measure cerebral embolic rates. Standardized neuropsychological testing was conducted 1 week before and 6 weeks after surgery. The raw scores for each test were converted to Z scores, and then a combined Z score of 10 main variables was calculated for both study groups. The primary analysis was based on dichotomous composite cognitive outcome with a 1-SD rule. Cognitive dysfunction was present in 6% (95% confidence interval, 1.3% to 10.7%) of patients in the cell saver group and 15% (95% confidence interval, 8% to 22%) of patients in the control group 6 weeks after surgery (P=0.038). The severity of aortic atheroma and cerebral embolic count were similar between the 2 groups.
  
  
  CONCLUSIONS
  The present report demonstrates that processing of shed blood with cell saver results in clinically significant reduction in postoperative cognitive dysfunction after cardiac surgery. These findings emphasize the clinical importance of lipid embolization in contributing to postoperative cognitive decline in patients exposed to cardiopulmonary bypass.
authors.affiliation: Department of Anesthesia, Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada. george.djaiani@uhn.on.ca
authors.forename: George
authors.initials: G
authors.lastname: Djaiani
authors.forename: Ludwik
authors.initials: L
authors.lastname: Fedorko
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Robin
authors.initials: R
authors.lastname: Green
authors.forename: Jo
authors.initials: J
authors.lastname: Carroll
authors.forename: Michael
authors.initials: M
authors.lastname: Marcon
authors.forename: Jacek
authors.initials: J
authors.lastname: Karski
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D005260:Female; D006440:Hemofiltration; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged