title: Effects of cell-saving devices and filters on transfusion in cardiac surgery: a multicenter randomized study.
abstract: BACKGROUND
  Cell-saving devices (CS) are frequently used in cardiac surgery to reduce transfusion requirements, but convincing evidence from randomized clinical trials is missing. Filtration of salvaged blood in combination with the CS is widely used to improve the quality of retransfused blood, but there are no data to justify this approach.
  
  
  METHODS
  To determine the contribution of CS and filters on transfusion requirements, we performed a multicenter factorial randomized clinical trial in two academic and four nonacademic hospitals. Patients undergoing elective coronary, valve, or combined surgical procedures were included. The primary end point was the number of allogeneic blood products transfused in each group during hospital admission.
  
  
  RESULTS
  From 738 included patients, 716 patients completed the study (CS+filter, 175; CS, 189; filter, 175; neither CS nor filter, 177). There was no significant effect of CS or filter on the total number of blood products (fraction [95% confidence interval]: CS, 0.96 [0.79, 1.18]; filter, 1.17 [0.96, 1.43]). Use of a CS significantly reduced red blood cell transfusions within 24 hours (0.75 [0.61,0.92]), but not during hospital stay (0.86 [0.71, 1.05]). Use of a CS was significantly associated with increased transfusions of fresh frozen plasma (1.39 [1.04, 1.86]), but not with platelets (1.25 [0.93, 1.68]). Use of a CS significantly reduced the percentage of patients who received any transfusion (odds ratio [95% confidence interval]: 0.67 [0.49, 0.91]), whereas filters did not (0.92 [0.68, 1.25]).
  
  
  CONCLUSIONS
  Use of a CS, with or without a filter, does not reduce the total number of allogeneic blood products, but reduces the percentage of patients who need blood products during cardiac surgery.
authors.affiliation: Department of Intensive Care and Thorax Centre Twente, Medisch Spectrum Twente Enschede, Enschede, the Netherlands. Electronic address: j.vermeijden@mst.nl.
authors.forename: Wytze J
authors.initials: WJ
authors.lastname: Vermeijden
authors.affiliation: Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Klarenbosch
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Y John
authors.initials: YJ
authors.lastname: Gu
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
authors.affiliation: Department of Anesthesiology and Pain Therapy, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Buhre
authors.affiliation: Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Thomas W L
authors.initials: TW
authors.lastname: Scheeren
authors.affiliation: Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Johanna A M
authors.initials: JA
authors.lastname: Hagenaars
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands.
authors.forename: M Erwin S H
authors.initials: ME
authors.lastname: Tan
authors.affiliation: Department of Cardiac Anesthesia, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands.
authors.forename: Jo S E
authors.initials: JS
authors.lastname: Haenen
authors.affiliation: Department of Anesthesia, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Bras
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: van Oeveren
authors.affiliation: Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Edwin R
authors.initials: ER
authors.lastname: van den Heuvel
authors.affiliation: Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: Adrianus J
authors.initials: AJ
authors.lastname: de Vries
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D057725:Operative Blood Salvage / Q000295:instrumentation*