title: Transfusion of cell saver salvaged blood in neonates and infants undergoing open heart surgery significantly reduces RBC and coagulant product transfusions and donor exposures: results of a prospective, randomized, clinical trial.
abstract: OBJECTIVE
  To evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hrs, would decrease the number of postoperative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes.
  
  
  METHODS
  Prospective, randomized, controlled, clinical trial.
  
  
  METHODS
  Pediatric cardiac intensive care unit.
  
  
  METHODS
  Infants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Subjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hrs after collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups.
  
  
  RESULTS
  Children randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 vs. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hrs post-op (cell saver: 0.09 ± 0.45 vs. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 vs. control: 2.3 ± 4.8; p = 0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 vs. control: 1.1 ± 1.4; p = 0.07). There were no significant clinical outcome differences.
  
  
  CONCLUSIONS
  Cell saver blood can be safely stored at the bedside for immediate transfusion for 24 hrs after collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate postoperative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease postoperative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.
authors.affiliation: Department of Pediatrics, University of Rochester, Rochester, NY, USA. Jill_Cholette@urmc.rochester.edu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
authors.forename: Karen S
authors.initials: KS
authors.lastname: Powers
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
authors.forename: Ronald
authors.initials: R
authors.lastname: Angona
authors.forename: Kelly F
authors.initials: KF
authors.lastname: Henrichs
authors.forename: Debra
authors.initials: D
authors.lastname: Masel
authors.forename: Michael F
authors.initials: MF
authors.lastname: Swartz
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Daugherty
authors.forename: Kevin
authors.initials: K
authors.lastname: Belmont
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
mesh_terms: D001804:Blood Transfusion, Autologous; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D017707:Erythrocyte Transfusion; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D008297:Male; D057725:Operative Blood Salvage; D010949:Plasma; D017713:Platelet Transfusion; D011182:Postoperative Care; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein