Intraoperative blood salvage and retransfusion from citrate treated wounds is safe and feasible.
OBJECTIVE
Allogenic blood transfusions are associated with increased morbidity and mortality in surgical patients. The study objective was to investigate the feasibility and safety of intraoperative autotransfusion of unwashed shed whole blood using a novel method.


METHODS
Twenty pigs were randomised to autotransfusion or crystalloid volume replacement. In two separate surgical wounds, the surfaces and 400 ml of shed blood were treated in situ with citrate, delivered with an equipment transforming suction to positive pressure. Central haemodynamics were monitored with a pulmonary artery catheter. Effects on oxygen-carrying capacity, formed blood elements, haemolysis, inflammation, metabolism, and coagulation were evaluated with biochemical analyses.


RESULTS
No clinically relevant adverse effects on haemodynamics were encountered, apart from a decrease in cardiac output and mixed venous saturation similar to that in control animals. Haemoglobin level was better preserved in the autotransfused group (97 vs. 86 g/L, p=0.0007). There were no major differences in biochemical variables and no macroscopic clot formation precluding autotransfusion.


CONCLUSIONS
The technique was safe and feasible for intraoperative blood salvage and autotransfusion. Haemodynamics and biochemical variables were similar to controls. The technique warrants further studies in humans, as it may contribute towards a reduction of allogenic blood transfusions.
Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. christian.olsson@karolinska.se
Christian
C
Olsson
Per
P
Olsson
Kjell
K
Rådegran
Anders
A
Owall
D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D006348:Cardiac Surgical Procedures; D002951:Citrates / Q000494:pharmacology*; D000077324:Crystalloid Solutions; D005240:Feasibility Studies; D006325:Heart Atria / Q000601:surgery; D006439:Hemodynamics; D007430:Intraoperative Care; D007552:Isotonic Solutions / Q000008:administration & dosage; D023421:Models, Animal; D010952:Plasma Substitutes / Q000008:administration & dosage; D000077559:Sodium Citrate; D013552:Swine; D013997:Time Factors
D000925:Anticoagulants; D015415:Biomarkers; D002951:Citrates; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077559:Sodium Citrate