Additional postoperative cell salvage of shed mediastinal blood in cardiac surgery does not reduce allogeneic blood transfusions: a cohort study.
Does additional postoperative collection and processing of mediastinal shed blood with a cell salvage device reduce the number of allogeneic blood transfusions compared to intraoperative cell salvage alone?



A single-centre cohort study in which adult patients with coronary artery bypass grafting or aortic valve replacement were allocated to either a C.A.T.S(®) group with intraoperative blood processing only or a CardioPat(®) group with both intra- and postoperative blood processing. The primary endpoint was the number of allogeneic blood transfusions during hospital admission.



The study included 99 patients; 50 in the C.A.T.S(®) and 49 in the CardioPat(®) group.There was no difference in the number of red blood cells (RBC) (C.A.T.S(®) group 43 units versus CardioPat(®) 50 units, p=0.74), fresh frozen plasma (C.A.T.S(®) 8 units versus CardioPat(®) 8 units, p=1.00) or platelets (C.A.T.S(®) 5 units versus CardioPat(®) 4 units, p=1.00) transfused during the hospital stay.Cardiac creatinine kinase (CK-MB) and troponin levels did not differ between the groups although a significant time effect (p<0.001) was present. Creatinine kinase (CK) levels were not different between the groups three hours after arrival in the intensive care unit (ICU) (CardioPat(®) group versus C.A.T.S(®) group, p=0.17). But, compared to the C.A.T.S(®) group on the first (350 [232-469] IU/L) and second postoperative days (325 [201-480] IU/L), the increase in CK levels was more in the CardioPat(®) group on the first (431 [286-642] IU/L, p=0.02) and second postoperative days (406 [239-760] IU/L, p=0.05), resulting in a difference between the groups (p=0.04) CONCLUSIONS: Postoperative cell salvage does not reduce transfusion requirements compared to intraoperative cell salvage alone, but results in elevated total CK levels that suggest haemolysis.
Department of Intensive Care and Thorax Centre Twente, Medisch Spectrum Twente, Enschede, the Netherlands j.vermeijden@mst.nl.
Wytze J
WJ
Vermeijden
Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands.
Johanna Am
JA
Hagenaars
Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands.
Thomas Wl
TW
Scheeren
Department of Anesthesiology, University Medical Centre Groningen, Groningen, the Netherlands.
Adrianus J
AJ
de Vries
D000368:Aged; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D001810:Blood Volume; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*
D006454:Hemoglobins; D003402:Creatine Kinase
auto transfusion; blood transfusion; cell salvage; haemolysis