title: Cell salvage of cardiotomy suction blood improves the balance between pro- and anti-inflammatory cytokines after cardiac surgery.
abstract: OBJECTIVE
  The inflammatory response after cardiac surgery is characterized by a profound release of pro- and anti-inflammatory cytokines. Recent data suggest that the balance between pro- and anti-inflammatory cytokines is of greater importance than the absolute levels. Retransfusion of unwashed cardiotomy suction blood contributes to the inflammatory response, but the balance between pro- and anti-inflammatory cytokines in cardiotomy suction blood and whether cell salvage before retransfusion influences the systemic balance have not been investigated previously.
  
  
  METHODS
  Twenty-five coronary artery bypass grafting patients were randomized to either cell salvage of cardiotomy suction blood or no cell salvage before retransfusion. Plasma levels of three anti-inflammatory cytokines [interleukin (IL)-1 receptor antagonist, IL-4 and IL-10] and two proinflammatory cytokines (tumour necrosis factor-alpha and IL-6), and the IL-6-to-IL-10 ratio was measured in cardiotomy suction blood before and after cell salvage, and in the systemic circulation before, during and after surgery.
  
  
  RESULTS
  Plasma levels of all cytokines except IL-4 and IL-10 were significantly higher in cardiotomy suction blood than in the systemic circulation. The IL-6-to-IL-10 ratio was 6-fold higher in cardiotomy suction blood than in the systemic circulation [median 10.2 (range 1.1-75) vs 1.7 (0.2-24), P < 0.001]. Cell salvage reduced plasma levels of cytokines in cardiotomy suction blood and improved the systemic IL-6-to-IL-10 ratio 24 h after surgery [median 5.2 (3.6-17) vs 12.4 (4.9-31)] compared with no cell salvage (P = 0.032).
  
  
  CONCLUSIONS
  The balance of pro- and anti-inflammatory cytokines in cardiotomy suction blood is unfavourable. Cell salvage reduces the absolute levels of both pro- and anti-inflammatory cytokines in cardiotomy suction blood and improves the balance in the systemic circulation after surgery.
authors: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Jakob
authors: J
authors: Gäbel
authors: Martin
authors: M
authors: Westerberg
authors: Anders
authors: A
authors: Bengtsson
authors: Anders
authors: A
authors: Jeppsson
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D016207:Cytokines / Q000097:blood / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D057725:Operative Blood Salvage / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D013396:Suction / Q000379:methods*
chemical_list: D016207:Cytokines
keywords: Cardiotomy suction; Cell salvage; Cytokines; Extracorporeal circulation; Inflammation