title: Intraoperative cell salvage is associated with reduced postoperative blood loss and transfusion requirements in cardiac surgery: a cohort study.
abstract: BACKGROUND
  This study investigated whether implementation of cell salvage of shed mediastinal and residual blood in all patients undergoing low-to-moderate-risk cardiac surgery reduces the need for allogeneic red blood cell (RBC) transfusion compared to patients not subjected to cell salvage.
  
  
  METHODS
  This retrospective cohort study included patients undergoing low-to-moderate-risk cardiac surgery with cardiopulmonary bypass without (control; n = 531) or with cell salvage (n = 433; Autolog, Medtronic). Study endpoints, including 24-hour blood loss and RBC requirements, were evaluated using adjusted logistic regression.
  
  
  RESULTS
  Baseline characteristics were similar between groups. The cell saver group received 568 ± 267 mL of autologous blood. Median number of allogeneic RBC transfusions was higher in the control group (2 [1-5]) compared with the cell salvage group (1 [0-3]; p < 0.001). There were no clinically relevant differences in postoperative coagulation test results between groups. The relative risk (RR) for postoperative RBC transfusion was reduced to 0.76 (95% confidence interval [CI], 0.70-0.83; p < 0.0001) in the cell salvage group. Moreover, patients in the cell salvage group had a lower chance for myocardial infarction (RR, 0.26; 95% CI, 0.08-0.91; p = 0.035), whereas the cell salvage group was associated with a higher probability for intensive care discharge within 24 hours after surgery (RR, 1.08; 95% CI, 1.02-1.14; p = 0.009).
  
  
  CONCLUSIONS
  The use of cell salvage throughout the entire procedure reduces postoperative blood loss and allogeneic RBC transfusion. These findings advocate implementation of cell salvage in all patients undergoing on-pump cardiac surgery, irrespective of anticipated surgery-related blood loss.
authors: Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands; Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
authors: Alexander B A
authors: AB
authors: Vonk
authors: Michael I
authors: MI
authors: Meesters
authors: Robert P
authors: RP
authors: Garnier
authors: Johannes W A
authors: JW
authors: Romijn
authors: Lerau J M
authors: LJ
authors: van Barneveld
authors: Martijn W
authors: MW
authors: Heymans
authors: Evert K
authors: EK
authors: Jansen
authors: Christa
authors: C
authors: Boer
mesh_terms: D000368:Aged; D001804:Blood Transfusion, Autologous / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies