1
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Pabón-Carrasco M, Cáceres-Matos R, Martínez-Flores S, Luque-Oliveros M. The effectiveness of cell salvage in extracorporeal circulation surgeries in relation to use of health resources after use: A systematic review and meta-analysis. Heliyon 2024; 10:e30459. [PMID: 38720744 PMCID: PMC11077044 DOI: 10.1016/j.heliyon.2024.e30459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
Background Alternatives to allogeneic blood transfusions are sought for resource management reasons and it is necessary to investigate the efficiency and efficacy on Cell Salvage use. The objective of this study is to analyze the effectiveness of the Cell Salvage system in addressing factors related to healthcare service utilization that may lead to increased healthcare expenditure. Methods A systematic review with meta-analysis was conducted through literature search in Medline, CINAHL, Scopus, Web of Science, and Cochrane Library. Inclusion criteria were studies in English/Spanish, without year restriction and Randomized Controlled Trials design, conducted in adults. Results Twenty-six studies were included in the systematic review, involving a total of 4781 patients (nexperimental group = 2365; ncontrol group = 2416). Significant differences favored the Cell Salvage system in units of transfused Red Blood Cells, in terms of units (p = 0.04; SMD = -0.42 95 % CI = -0.83 to -0.02) and individuals (p = 0.001; RR = 0.71, 95 % CI = 0.60 to 0.84) transfused. No significant differences were found in ICU (p = 0.93) and hospital stay duration (p = 0.21), number of reoperations (p = 0.68), and number of units and individuals transfused in terms of platelets (p > 0.05). Conclusions Cell Salvage use holds high potential for reducing healthcare costs and indirectly contributing to improving blood and blood product reserves within blood banks. Results obtained thus far do not provide definitive evidence regarding the duration of hospital stay, ICU stay, need for reoperation, or the quantity of transfused platelets. Therefore, it is recommended to increase the number of studies to assess the impact on the economic models of the Cell Salvage system.
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Affiliation(s)
- Manuel Pabón-Carrasco
- Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009, Sevilla, Spain
- “CTS-1054: Interventions and Health Care, Red Cross (ICSCRE)”, Spain
| | - Rocío Cáceres-Matos
- Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009, Sevilla, Spain
- Research Group CTS-1050: “Complex Care, Chronicity and Health Outcomes”, 6 Avenzoar ST, RI, 41009, Seville, Spain
| | - Salvador Martínez-Flores
- Cardiovascular and Thoracic Surgery Operating Theatre Unit of the Virgen Macarena University Hospital, Seville, Spain
| | - Manuel Luque-Oliveros
- Cardiovascular and Thoracic Surgery Operating Theatre Unit of the Virgen Macarena University Hospital, Seville, Spain
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2
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Morinaga M, Yoshitani K, Ogata S, Fukushima S, Matsuda H. Association between intraoperative blood salvage and coagulation disorder after cardiopulmonary bypass. JA Clin Rep 2024; 10:5. [PMID: 38270666 PMCID: PMC10810763 DOI: 10.1186/s40981-024-00689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND This study investigated whether intraoperative blood salvage was associated with coagulation disorder diagnosed by conventional coagulation tests and thromboelastography (TEG) after cardiopulmonary bypass (CPB). STUDY DESIGN AND METHODS This was a prospective, observational study. Ninety-two patients who underwent cardiovascular surgery with CPB were enrolled. We evaluated coagulation function in patients with or without cell salvage blood transfusion at the following time points: before CPB, just after protamine administration, and 1 h after protamine administration. We evaluated platelet count, fibrinogen concentration, and TEG parameters. Patients were considered to have coagulation disorder if one or more of the following criteria were present: (1) residual heparin, (2) low platelet count, (3) low fibrinogen level, (4) low clotting factor level, and (5) hyperfibrinolysis. RESULTS Fifty-three of 92 patients (57.6%) received intraoperative cell salvage. Coagulation disorder was observed in 56 of 92 patients (60.9%) after CPB. There was no significant difference between patients with or without intraoperative blood salvage in terms of the incidence of coagulation disorder (p = 0.542) or the total volume of blood from the drain after CPB (p = 0.437). Intraoperative blood salvage was not associated with coagulation disorder diagnosed by either TEG or conventional coagulation tests (odds ratio 1.329, 95% confidence interval: 0.549-3.213, p = 0.547). There were no significant interactions between patients with or without intraoperative blood salvage regarding coagulation parameters derived from TEG. CONCLUSIONS The incidence of coagulation disorder and the total blood volume from the drain after CPB did not differ significantly between patients with or without intraoperative blood salvage.
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Affiliation(s)
- Masahiro Morinaga
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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3
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Abbasciano RG, Tomassini S, Roman MA, Rizzello A, Pathak S, Ramzi J, Lucarelli C, Layton G, Butt A, Lai F, Kumar T, Wozniak MJ, Murphy GJ. Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults. Cochrane Database Syst Rev 2023; 10:CD013584. [PMID: 37873947 PMCID: PMC10594589 DOI: 10.1002/14651858.cd013584.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury. A wide range of organ protection interventions targeting the innate immune response have been evaluated in randomised controlled trials (RCTs) in adult cardiac surgery patients, with inconsistent results in terms of effectiveness. OBJECTIVES The aim of the review was to summarise the results of RCTs of organ protection interventions targeting the innate immune response in adult cardiac surgery. The review considered whether the interventions had a treatment effect on inflammation, important clinical outcomes, or both. SEARCH METHODS CENTRAL, MEDLINE, Embase, conference proceedings and two trial registers were searched on October 2022 together with reference checking to identify additional studies. SELECTION CRITERIA RCTs comparing organ protection interventions targeting the innate immune response versus placebo or no treatment in adult patients undergoing cardiac surgery where the treatment effect on innate immune activation and on clinical outcomes of interest were reported. DATA COLLECTION AND ANALYSIS Searches, study selection, quality assessment, and data extractions were performed independently by pairs of authors. The primary inflammation outcomes were peak IL-6 and IL-8 concentrations in blood post-surgery. The primary clinical outcome was in-hospital or 30-day mortality. Treatment effects were expressed as risk ratios (RR) and standardised mean difference (SMD) with 95% confidence intervals (CI). Meta-analyses were performed using random effects models, and heterogeneity was assessed using I2. MAIN RESULTS A total of 40,255 participants from 328 RCTs were included in the synthesis. The effects of treatments on IL-6 (SMD -0.77, 95% CI -0.97 to -0.58, I2 = 92%) and IL-8 (SMD -0.92, 95% CI -1.20 to -0.65, I2 = 91%) were unclear due to heterogeneity. Heterogeneity for inflammation outcomes persisted across multiple sensitivity and moderator analyses. The pooled treatment effect for in-hospital or 30-day mortality was RR 0.78, 95% CI 0.68 to 0.91, I2 = 0%, suggesting a significant clinical benefit. There was little or no treatment effect on mortality when analyses were restricted to studies at low risk of bias. Post hoc analyses failed to demonstrate consistent treatment effects on inflammation and clinical outcomes. Levels of certainty for pooled treatment effects on the primary outcomes were very low. AUTHORS' CONCLUSIONS A systematic review of RCTs of organ protection interventions targeting innate immune system activation did not resolve uncertainty as to the effectiveness of these treatments, or the role of innate immunity in organ injury following cardiac surgery.
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Affiliation(s)
| | | | - Marius A Roman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Angelica Rizzello
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Suraj Pathak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Joussi Ramzi
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Carla Lucarelli
- Department of Cardiac Surgery, University of Verona, Verona, Italy
| | - Georgia Layton
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ayesha Butt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Florence Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Tracy Kumar
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Marcin J Wozniak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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4
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Lloyd TD, Geneen LJ, Bernhardt K, McClune W, Fernquest SJ, Brown T, Dorée C, Brunskill SJ, Murphy MF, Palmer AJ. Cell salvage for minimising perioperative allogeneic blood transfusion in adults undergoing elective surgery. Cochrane Database Syst Rev 2023; 9:CD001888. [PMID: 37681564 PMCID: PMC10486190 DOI: 10.1002/14651858.cd001888.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Concerns regarding the safety and availability of transfused donor blood have prompted research into a range of techniques to minimise allogeneic transfusion requirements. Cell salvage (CS) describes the recovery of blood from the surgical field, either during or after surgery, for reinfusion back to the patient. OBJECTIVES To examine the effectiveness of CS in minimising perioperative allogeneic red blood cell transfusion and on other clinical outcomes in adults undergoing elective or non-urgent surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two clinical trials registers for randomised controlled trials (RCTs) and systematic reviews from 2009 (date of previous search) to 19 January 2023, without restrictions on language or publication status. SELECTION CRITERIA We included RCTs assessing the use of CS compared to no CS in adults (participants aged 18 or over, or using the study's definition of adult) undergoing elective (non-urgent) surgery only. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 106 RCTs, incorporating data from 14,528 participants, reported in studies conducted in 24 countries. Results were published between 1978 and 2021. We analysed all data according to a single comparison: CS versus no CS. We separated analyses by type of surgery. The certainty of the evidence varied from very low certainty to high certainty. Reasons for downgrading the certainty included imprecision (small sample sizes below the optimal information size required to detect a difference, and wide confidence intervals), inconsistency (high statistical heterogeneity), and risk of bias (high risk from domains including sequence generation, blinding, and baseline imbalances). Aggregate analysis (all surgeries combined: primary outcome only) Very low-certainty evidence means we are uncertain if there is a reduction in the risk of allogeneic transfusion with CS (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.59 to 0.72; 82 RCTs, 12,520 participants). Cancer: 2 RCTs (79 participants) Very low-certainty evidence means we are uncertain whether there is a difference for mortality, blood loss, infection, or deep vein thrombosis (DVT). There were no analysable data reported for the remaining outcomes. Cardiovascular (vascular): 6 RCTs (384 participants) Very low- to low-certainty evidence means we are uncertain whether there is a difference for most outcomes. No data were reported for major adverse cardiovascular events (MACE). Cardiovascular (no bypass): 6 RCTs (372 participants) Moderate-certainty evidence suggests there is probably a reduction in risk of allogeneic transfusion with CS (RR 0.82, 95% CI 0.69 to 0.97; 3 RCTs, 169 participants). Very low- to low-certainty evidence means we are uncertain whether there is a difference for volume transfused, blood loss, mortality, re-operation for bleeding, infection, wound complication, myocardial infarction (MI), stroke, and hospital length of stay (LOS). There were no analysable data reported for thrombosis, DVT, pulmonary embolism (PE), and MACE. Cardiovascular (with bypass): 29 RCTs (2936 participants) Low-certainty evidence suggests there may be a reduction in the risk of allogeneic transfusion with CS, and suggests there may be no difference in risk of infection and hospital LOS. Very low- to moderate-certainty evidence means we are uncertain whether there is a reduction in volume transfused because of CS, or if there is any difference for mortality, blood loss, re-operation for bleeding, wound complication, thrombosis, DVT, PE, MACE, and MI, and probably no difference in risk of stroke. Obstetrics: 1 RCT (1356 participants) High-certainty evidence shows there is no difference between groups for mean volume of allogeneic blood transfused (mean difference (MD) -0.02 units, 95% CI -0.08 to 0.04; 1 RCT, 1349 participants). Low-certainty evidence suggests there may be no difference for risk of allogeneic transfusion. There were no analysable data reported for the remaining outcomes. Orthopaedic (hip only): 17 RCTs (2055 participants) Very low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, or if there is any difference between groups for mortality, blood loss, re-operation for bleeding, infection, wound complication, prosthetic joint infection (PJI), thrombosis, DVT, PE, stroke, and hospital LOS. There were no analysable data reported for MACE and MI. Orthopaedic (knee only): 26 RCTs (2568 participants) Very low- to low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, and whether there is a difference for blood loss, re-operation for bleeding, infection, wound complication, PJI, DVT, PE, MI, MACE, stroke, and hospital LOS. There were no analysable data reported for mortality and thrombosis. Orthopaedic (spine only): 6 RCTs (404 participants) Moderate-certainty evidence suggests there is probably a reduction in the need for allogeneic transfusion with CS (RR 0.44, 95% CI 0.31 to 0.63; 3 RCTs, 194 participants). Very low- to moderate-certainty evidence suggests there may be no difference for volume transfused, blood loss, infection, wound complication, and PE. There were no analysable data reported for mortality, re-operation for bleeding, PJI, thrombosis, DVT, MACE, MI, stroke, and hospital LOS. Orthopaedic (mixed): 14 RCTs (4374 participants) Very low- to low-certainty evidence means we are uncertain if there is a reduction in the need for allogeneic transfusion with CS, or if there is any difference between groups for volume transfused, mortality, blood loss, infection, wound complication, PJI, thrombosis, DVT, MI, and hospital LOS. There were no analysable data reported for re-operation for bleeding, MACE, and stroke. AUTHORS' CONCLUSIONS In some types of elective surgery, cell salvage may reduce the need for and volume of allogeneic transfusion, alongside evidence of no difference in adverse events, when compared to no cell salvage. Further research is required to establish why other surgeries show no benefit from CS, through further analysis of the current evidence. More large RCTs in under-reported specialities are needed to expand the evidence base for exploring the impact of CS.
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Affiliation(s)
- Thomas D Lloyd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | | | | | - Scott J Fernquest
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tamara Brown
- School of Health, Leeds Beckett University, Leeds, UK
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
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5
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The Effect of Cell Salvage on Bleeding and Transfusion Needs in Cardiac Surgery. Anesthesiol Res Pract 2022; 2022:3993452. [PMID: 36092853 PMCID: PMC9458370 DOI: 10.1155/2022/3993452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/10/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Cell salvaging is well established in the blood management of cardiac patients, but there remain some concerns about its effects on perioperative bleeding and transfusion variables. This randomized controlled study investigated the potential effects of the centrifuged end-product on bleeding, transfusion rates, and other transfusion-related variables in adult cardiac surgery patients submitted to extracorporeal circulation. Materials and Methods. Patients were randomly chosen to receive (cell-salvage group, 99 patients) or not to receive (control group, 110 patients) the centrifuged product of a cell salvage apparatus. Bleeding and transfusion rates according to the universal definition of perioperative bleeding (UDPB) classification, postoperative hemoglobin, coagulation, and oxygenation indices were recorded and compared between the groups. Results. Both groups had almost identical bleeding and transfusion rates (median value: 2 units of red blood cells (RBC) and no units of fresh frozen plasma (FFP) and platelets (PLT) for both groups,
). Patients in the cell-salvage group presented slightly higher hemoglobin concentrations (10.6 ± 1.1 vs. 10.1 ± 1.7 g/dL,
, respectively) and a tendency towards better oxygenation indices (PaO2/FiO2: 241 ± 94 vs. 207 ± 84,
) in the postoperative period albeit with a tendency for prolongation of prothrombin time (INR: 1.31 ± 0.18 vs. 1.26 ± 0.12,
). Conclusion. Within the study’s constraints, the perioperative use of the cell salvage concentrate does not seem to affect bleeding or transfusion variables, although it could probably ameliorate postoperative oxygenation in adult cardiac surgery patients. A tendency to promote coagulation disturbances was detected.
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6
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Wahba A, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Puis L. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 2021; 57:210-251. [PMID: 31576396 DOI: 10.1093/ejcts/ezz267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
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7
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Puis L, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Wahba A. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Interact Cardiovasc Thorac Surg 2020; 30:161-202. [PMID: 31576402 PMCID: PMC10634377 DOI: 10.1093/icvts/ivz251] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav s University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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8
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Kunst G, Milojevic M, Boer C, De Somer FM, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Puis L, Wahba A, Alston P, Fitzgerald D, Nikolic A, Onorati F, Rasmussen BS, Svenmarker S. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth 2019; 123:713-757. [DOI: 10.1016/j.bja.2019.09.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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9
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Al Khabori M, Al Riyami A, Siddiqi MS, Sarfaraz ZK, Ziadinov E, Al Sabti H. Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta‐analysis. Vox Sang 2019; 114:553-565. [DOI: 10.1111/vox.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/25/2019] [Accepted: 06/12/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | - Arwa Al Riyami
- Department of Hematology Sultan Qaboos University Hospital Muscat Oman
| | | | | | - Edem Ziadinov
- Department of Cardiac Surgery Sultan Qaboos University Hospital Muscat Oman
| | - Hilal Al Sabti
- Department of Cardiac Surgery Sultan Qaboos University Hospital Muscat Oman
- Oman Medical Specialty Board Muscat Oman
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10
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Cell salvage processing of residual cardiopulmonary bypass volume in minimally invasive cardiac surgery. Heart Vessels 2019; 34:1280-1286. [PMID: 30810800 DOI: 10.1007/s00380-019-01365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
Several reports demonstrated positive effects of processing residual cardiopulmonary bypass volume using a cell salvage device in conventional open heart surgery via sternotomy on hemostasis. The present study aimed to investigate whether cell salvage processing has the same effects on postoperative blood loss and transfusion in minimally invasive cardiac surgery. Between July 2015 and April 2018, 80 consecutive patients undergoing minimally invasive aortic valve replacement via right anterolateral minithoracotomy were enrolled in the present study. Perioperative outcomes and coagulation data of 40 patients who were retransfused with processed cardiopulmonary bypass volumes were compared with those of 40 patients receiving unprocessed residual blood (control group). Postoperative blood loss in patients receiving processed residual blood was significantly less than that in the control group at 6 h (115 ± 50 vs. 73 ± 33 ml, p < 0.001) and 12 h (167 ± 70 vs. 125 ± 67 ml, p = 0.009) after surgery, and the rate of fresh frozen plasma use after surgery was significantly reduced in patients receiving processed residual blood (18 vs. 0%, p = 0.012). In conclusion, processing of residual cardiopulmonary bypass volume reduced postoperative blood loss and postoperative use of fresh frozen plasma and could be useful for hemostasis in minimally invasive cardiac surgery.
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11
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Yan S, Zhao Y, Lou S. Ultrafiltration and reinfusion of residual cardiopulmonary bypass pump blood: A prospective non‐randomized controlled study. Artif Organs 2019; 43:641-646. [PMID: 30589449 DOI: 10.1111/aor.13412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Shujie Yan
- Department of Cardiopulmonary Bypass, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Yu Zhao
- Department of Neurological Intervention Rocket Force General Hospital Beijing China
| | - Song Lou
- Department of Cardiopulmonary Bypass, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College Beijing China
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12
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Boyle G, Kuffel A, Parmar K, Gibson K, Smith M, Grehan A, Hunt BJ, Chambers DJ. A comparison of haemostatic biomarkers during low-risk patients undergoing cardiopulmonary bypass using either conventional centrifugal cell salvage or the HemoSep device. Perfusion 2018; 34:76-83. [PMID: 30067140 DOI: 10.1177/0267659118789051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac surgery using cardiopulmonary bypass (CPB) is associated with a coagulopathy due to haemodilution, thrombocytopenia and platelet dysfunction and the activation of coagulation and fibrinolysis, despite the use of large doses of unfractionated heparin. Conventional red cell salvage may exacerbate post-operative bleeding as plasma containing haemostatic factors is discarded. We hypothesized that a novel cell salvage device (HemoSep) may attenuate haemostatic changes associated with red cell salvage. We studied haemostatic markers following autologous transfusion from conventional cell salvage or the HemoSep device. METHODS This randomised, controlled trial compared haemostatic markers in patients undergoing coronary artery bypass grafting or aortic valve replacement who received autologous blood returned from cell salvage (control) or HemoSep (study). Blood samples were taken pre-operatively, end of CPB, post-transfusion of salvaged blood and 3 hours post-operatively and analysed for full blood count (FBC), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer and endogenous thrombin potential (ETP). RESULTS Fifty-four patients were recruited (n=28 control, n=26 study). Processed blood volume for transfusion was significantly (p<0.001) higher in the HemoSep group. In the HemoSep group, the PT was shorter (18.7±0.3 vs 19.9±0.3 sec; p<0.05) post-operatively and the aPTT was longer (48.6±3.8 vs 37.3±1.0 sec; p<0.01) following autologous transfusion. In the control group, D-dimer and ETP levels were higher (1903±424 vs.1088±151; p<0.05 and 739±46 vs. 394±60; p<0.001, respectively) following autologous transfusion. CONCLUSIONS Although centrifuged cell salvage is known to adequately haemoconcentrate and remove unwanted substrates and bacteriological contamination, the process can exacerbate coagulopathy. The HemoSep device demonstrated some increase in haemostatic markers when used in low-risk cardiac surgery patients.
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Affiliation(s)
- Gethin Boyle
- 1 Clinical Perfusion Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, UK
| | | | - Kiran Parmar
- 2 Thrombosis & Vascular Biology Group, The Rayne Institute, UK
| | - Kirsty Gibson
- 3 Cardiovascular Research, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, UK
| | - Megan Smith
- 3 Cardiovascular Research, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, UK
| | - Aidan Grehan
- 1 Clinical Perfusion Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, UK
| | - Beverley J Hunt
- 2 Thrombosis & Vascular Biology Group, The Rayne Institute, UK.,4 Thrombosis & Haemophilia, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, UK
| | - David J Chambers
- 5 Cardiothoracic Surgery/Cardiac Surgical Research, The Rayne Institute, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, UK
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13
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Sun GH, Patel V, Moreno-Duarte I, Zahedi F, Ursprung E, Couper G, Chen FY, Welsby IJ, Comenzo R, Kao G, Cobey FC. Intraoperative Administration of 4-Factor Prothrombin Complex Concentrate Reduces Blood Requirements in Cardiac Transplantation. J Cardiothorac Vasc Anesth 2018; 32:161-167. [DOI: 10.1053/j.jvca.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 11/11/2022]
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14
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Wang Z, Qian Z, Ren J, Men J, Wen J, Wei M. Long Period and High Level of D-Dimer after Coronary Artery Bypass Grafting Surgery. Int Heart J 2018; 59:51-57. [DOI: 10.1536/ihj.16-595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Zanxin Wang
- Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital
| | - Zhaoyang Qian
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital
| | - Jing Ren
- Department of Clinical Laboratory, Tianjin Medical University General Hospital
| | - Jianlong Men
- Department of Clinical Laboratory, Tianjin Medical University General Hospital
| | - Junmin Wen
- Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital
| | - Minxin Wei
- Department of Cardiac Surgery, Shenzhen Sun Yat-sen Cardiovascular Hospital
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15
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Côté CL, Yip AM, MacLeod JB, O'Reilly B, Murray J, Ouzounian M, Brown CD, Forgie R, Pelletier MP, Hassan A. Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study. Can J Surg 2017; 59:330-6. [PMID: 27668331 DOI: 10.1503/cjs.002216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Evidence regarding the safety and efficacy of intraoperative cell salvage (ICS) in transfusion reduction during cardiac surgery remains conflicting. We sought to evaluate the impact of routine ICS on outcomes following cardiac surgery. METHODS We conducted a retrospective analysis of patients who underwent nonemergent, first-time cardiac surgery 18 months before and 18 months after the implementation of routine ICS. Perioperative transfusion rates, postoperative bleeding, clinical and hematological outcomes, and overall cost were examined. We used multivariable logistic regression modelling to determine the risk-adjusted effect of ICS on likelihood of perioperative transfusion. RESULTS A total of 389 patients formed the final study population (186 undergoing ICS and 203 controls). Patients undergoing ICS had significantly lower perioperative transfusion rates of packed red blood cells (pRBCs; 33.9% v. 45.3% p = 0.021), coagulation products (16.7% v. 32.5% p < 0.001) and any blood product (38.2% v. 52.7%, p = 0.004). Patients receiving ICS had decreased mediastinal drainage at 12 h (mean 320 [range 230-550] mL v. mean 400 [range 260-690] mL, p = 0.011) and increased postoperative hemoglobin (mean 104.7 ± 13.2 g/L v. 95.0 ± 11.9 g/L, p < 0.001). Following adjustment for other baseline and intraoperative covariates, ICS emerged as an independent predictor of lower perioperative transfusion rates of pRBCs (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.87), coagulation products (OR 0.41, 95% CI 0.24-0.71) and any blood product (OR 0.47, 95% CI 0.29-0.77). Additionally, ICS was associated with a cost benefit of $116 per patient. CONCLUSION Intraoperative cell salvage could represent a clinically cost-effective way of reducing transfusion rates in patients undergoing cardiac surgery. Further research on systematic ICS is required before recommending it for routine use.
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Affiliation(s)
- Claudia L Côté
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Alexandra M Yip
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Jeffrey B MacLeod
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Bill O'Reilly
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Joshua Murray
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Maral Ouzounian
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Craig D Brown
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Rand Forgie
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Marc P Pelletier
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
| | - Ansar Hassan
- From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian)
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16
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Buys WF, Buys M, Levin AI. Reinfusate Heparin Concentrations Produced by Two Autotransfusion Systems. J Cardiothorac Vasc Anesth 2017; 31:90-98. [DOI: 10.1053/j.jvca.2016.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Indexed: 11/11/2022]
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17
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Schotola H, Wetz AJ, Popov AF, Bergmann I, Danner BC, Schöndube FA, Bauer M, Bräuer A. The Effects of Residual Pump Blood on Patient Plasma Free Haemoglobin Levels Post Cardiac Surgery. Anaesth Intensive Care 2016; 44:587-92. [DOI: 10.1177/0310057x1604400519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
At the end of cardiopulmonary bypass, there are invariably several hundred millilitres of residual pump blood in the reservoir, which can either be re-transfused or discarded. The objective of this prospective observational study was to investigate the quality of the residual pump blood, focusing on plasma free haemoglobin (pfHb) and blood cell counts. Fifty-one consecutive patients were included in the study. Forty-nine units of residual pump blood and 58 units of transfused red blood cell (RBC) concentrates were analysed. The mean preoperative pfHb of the patients was 0.057 ± 0.062 g/l, which increased gradually to 0.55 ± 0.36 g/l on arrival in the intensive care unit postoperatively. On the first postoperative day, the mean pfHb had returned to within the normal range. Our data showed that haemoglobin, haematocrit, and erythrocyte counts of residual pump blood were approximately 40% of the values in standardised RBC concentrates. Plasma free haemoglobin was significantly higher in residual pump blood compared to RBC concentrates, and nearly twice as high as the pfHb in patient blood samples taken contemporaneously. Our findings indicate that residual pump blood pfHb levels are markedly higher compared to patients' blood and RBC concentrates, but that its administration does not significantly increase patients' pfHb levels.
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Affiliation(s)
- H. Schotola
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - A. J. Wetz
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - A. F. Popov
- Department of Cardiothoracic Transplantation and Mechanical Support, Brompton and Harefield Hospital, London, United Kingdom
| | - I. Bergmann
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - B. C. Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Goettingen, Germany
| | - F. A. Schöndube
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Goettingen, Germany
| | - M. Bauer
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - A. Bräuer
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
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18
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Meybohm P, Choorapoikayil S, Wessels A, Herrmann E, Zacharowski K, Spahn DR. Washed cell salvage in surgical patients: A review and meta-analysis of prospective randomized trials under PRISMA. Medicine (Baltimore) 2016; 95:e4490. [PMID: 27495095 PMCID: PMC4979849 DOI: 10.1097/md.0000000000004490] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/20/2016] [Accepted: 07/12/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cell salvage is commonly used as part of a blood conservation strategy. However concerns among clinicians exist about the efficacy of transfusion of washed cell salvage. METHODS We performed a meta-analysis of randomized controlled trials in which patients, scheduled for all types of surgery, were randomized to washed cell salvage or to a control group with no cell salvage. Data were independently extracted, risk ratio (RR), and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random effects model. The primary endpoint was the number of patients exposed to allogeneic red blood cell (RBC) transfusion. RESULTS Out of 1140 search results, a total of 47 trials were included. Overall, the use of washed cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 39% (RR = 0.61; 95% CI 0.57 to 0.65; P < 0.001), resulting in an average saving of 0.20 units of allogeneic RBC per patient (weighted mean differences [WMD] = -0.20; 95% CI -0.22 to -0.18; P < 0.001), reduced risk of infection by 28% (RR = 0.72; 95% CI 0.54 to 0.97; P = 0.03), reduced length of hospital stay by 2.31 days (WMD = -2.31; 95% CI -2.50 to -2.11; P < 0.001), but did not significantly affect risk of mortality (RR = 0.92; 95% CI 0.63 to 1.34; P = 0.66). No statistical difference could be observed in the number of patients exposed to re-operation, plasma, platelets, or rate of myocardial infarction and stroke. CONCLUSIONS Washed cell salvage is efficacious in reducing the need for allogeneic RBC transfusion and risk of infection in surgery.
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Affiliation(s)
- Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt
| | - Suma Choorapoikayil
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt
| | - Anke Wessels
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt
| | - Eva Herrmann
- Institute for Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt
| | - Donat R. Spahn
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Germany
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19
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Shen S, Zhang J, Wang W, Zheng J, Xie Y. Impact of intra-operative cell salvage on blood coagulation in high-bleeding-risk patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial. J Transl Med 2016; 14:228. [PMID: 27473326 PMCID: PMC4966771 DOI: 10.1186/s12967-016-0986-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/20/2016] [Indexed: 02/06/2023] Open
Abstract
Background Intra-operative cell salvage (CS) was reported to have no impairment on blood coagulation in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the impact of CS on blood coagulation in high-bleeding-risk cardiac surgery with CPB. Methods One hundred and ten patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints included the incidence of impairment of blood coagulation during perioperative period (peri-op) and the incidence of adverse events during postoperative period (post-op). Peri-op was defined as the period from beginning of anesthesia (anesthesia induction) to 24 h after end of surgery. Post-op was defined as the period from the end of surgery to 24 h after end of surgery. The types of impairment of blood coagulation included heparin residual, coagulopathy due to low PLT, coagulopathy due to low FIB, coagulopathy due to low coagulation factors, hyperfibrinolytic. The sum of above five types was total impairment of blood coagulation. Adverse events included excessive bleeding, resternotomy, etc. Results The incidence of heparin residual measured both at the end of surgery and during post-op were significantly higher in Group CS than in Group C (15.09 vs 4.00, 13.21 vs 2.00 %; p = 0.024, 0.010, respectively). Similarly, the incidence of total impairment of blood coagulation at the end of surgery and during post-op were significantly higher in Group CS than in Group C (32.08 vs 18.00, 26.42 vs 12.00 %; p = 0.043, 0.040, respectively). The incidence of excessive bleeding during post-op was 32.08 % in Group CS compared with 16.00 % in Group C (p = 0.038). Intriguingly, CS was associated with a significantly increase in the relative risk ratios for heparin residual and excessive bleeding (p = 0.034, 0.049, respectively). Conclusions Intra-operative CS could impair blood coagulation in the scenario of high-risk-bleeding cardiac surgery with CPB.
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Affiliation(s)
- Sheliang Shen
- Department of Anesthesiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Wenyuan Wang
- Department of Anesthesiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jiayin Zheng
- Department of Probability and Statistics, School of Mathematical Sciences, Beijing University, Beijing, China
| | - Yihong Xie
- Department of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
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20
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Gielen CL, Brand A, van Heerde WL, Stijnen T, Klautz RJ, Eikenboom J. Hemostatic alterations during coronary artery bypass grafting. Thromb Res 2016; 140:140-146. [DOI: 10.1016/j.thromres.2015.12.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/16/2015] [Accepted: 12/23/2015] [Indexed: 11/28/2022]
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21
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Iyer YL, Hayward P, McNicol L, Weinberg L. The effects on coagulation of the reinfusion of unprocessed residual blood from the cardiopulmonary bypass. BMC Res Notes 2016; 9:61. [PMID: 26843072 PMCID: PMC4739327 DOI: 10.1186/s13104-016-1868-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/16/2016] [Indexed: 12/04/2022] Open
Abstract
Background
Autologous blood transfusion is a common technique in cardiac surgery to directly re-infuse residual blood from the cardiopulmonary bypass (CPB) circuit to the patient. The objective of this study was to evaluate the effects of reinfusion of unprocessed residual pump blood on the coagulation system after separation from the CPB circuit and reversal of systemic heparin with protamine.
Measurements and main results
After ethics approval, 40 participants undergoing cardiac surgery were recruited in a prospective single center cohort study. Changes in coagulation were assessed with standard plasma based laboratory assays and thromboelastography. After the reinfusion of unprocessed residual pump blood there were decreases in the mean aPTT (effect size 6 s; SD: 6.05; p < 0.0001) and thrombin time (effect size 4.08 s; SD: 9.7; p = 0.01). There were no significant changes in PT, INR and D-dimer. Post reinfusion there were increases in fibrinogen, hemoglobin and platelet counts. There were improvements in the R-time (effect size 9.1 s; SD: 16.9; p = 0.0023), K-time (effect size 1.5 s; SD: 3.6 s; p = 0.0017), alpha angle (6.9°; SD: 15.8; p = 0.012), and maximum amplitude (3.0 mm; SD: 5.6, p = 0.002) on thromboelastography. Conclusion The reinfusion of unprocessed residual CPB blood resulted in no deleterious effects on the coagulation system measured by both the common laboratory plasma based measurements of coagulation and thromboelastography.
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Affiliation(s)
- Yolande-Leigh Iyer
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, VIC, Australia.
| | - Philip Hayward
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, VIC, Australia. .,Department of Surgery, University of Melbourne, Parkville, VIC, Australia.
| | - Larry McNicol
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia. .,Department of Anaesthesia, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia.
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia. .,Department of Surgery and Centre for Anaesthesia, Perioperative and Pain Medicine, University of Melbourne, Parkville, VIC, Australia.
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22
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Hwang NC. Preventive Strategies for Minimizing Hemodilution in the Cardiac Surgery Patient During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2015; 29:1663-71. [DOI: 10.1053/j.jvca.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 11/11/2022]
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23
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Xie Y, Shen S, Zhang J, Wang W, Zheng J. The efficacy, safety and cost-effectiveness of intra-operative cell salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial. Int J Med Sci 2015; 12:322-8. [PMID: 25897293 PMCID: PMC4402435 DOI: 10.7150/ijms.11227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/16/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Intra-operative cell salvage (CS) was reported to be ineffective, safe and not cost-effective in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the efficacy, safety and cost-effectiveness of intra-operative CS in high-bleeding-risk cardiac surgery with CPB. METHODS One hundred and fifty patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints were defined as perioperative allogeneic red blood cell (RBC) transfusion, perioperative impairment of blood coagulative function, postoperative adverse events and costs of transfusion-related. RESULTS Both the proportion and quantity of perioperative allogeneic RBC transfusion were significantly lower in Group CS than that in Group C (p=0.0002, <0.0001, respectively). The incidence of residual heparin and total impairment of blood coagulative function in the 24 hours after surgery, the incidence of postoperative excessive bleeding, were significantly higher in Group CS than that in Group C (p=0.018, 0.042, 0.034, respectively). Cost of both allogeneic RBC transfusion and total allogeneic blood transfusion were significantly lower in Group CS than that in Group C (p<0.001, =0.002, respectively). Cost of total blood transfusion was significantly higher in Group CS than that in Group C (p =0.001). CONCLUSION Intra-operative CS in high-bleeding-risk cardiac surgery with CPB is effective, generally safe, and cost-effective in developed countries but not in China.
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Affiliation(s)
- Yihong Xie
- 1. Department of Cardiothoracic surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Sheliang Shen
- 2. Department of Anesthesiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jun Zhang
- 3. Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Wenyuan Wang
- 2. Department of Anesthesiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jiayin Zheng
- 4. Department of Probability and Statistics, School of Mathematical Sciences, Beijing University, Beijing, China
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24
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Lilly KJ, Pirundini PA, Fox AA, Body SC, Shaw C, Rizzo RJ. Restoration of the coagulation cascade on CPB: a case report. Perfusion 2013; 29:272-4. [DOI: 10.1177/0267659113507471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Coagulopathy can sometimes be observed when CPB times are prolonged. Correction of coagulopathy post CPB can present the surgical team with a number of challenges, including right ventricular volume overload, hemodilution, anemia and excessive cell salvage with further loss of coagulation factors. Restoration of the coagulation cascade on CPB may help to avoid these issues. This case report is of a 64-year-old male with a delayed diagnosis of aortic dissection. The patient presented to the cardiac surgery operating room with hepatic and renal shock/failure, with the resulting coagulopathy. The described technique is representative of a technique that we sometimes employ to restore the clotting mechanism before separating from bypass.
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Affiliation(s)
- KJ Lilly
- Division of Cardiac Surgery, Brigham & Women’s/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA
| | - PA Pirundini
- Division of Cardiac Surgery, Brigham & Women’s/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA
| | - AA Fox
- Division of Cardiac Surgery, Brigham & Women’s/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA
| | - SC Body
- Division of Cardiac Anesthesiology, Brigham & Women’s/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA
| | - C Shaw
- Division of Cardiac Surgery, Brigham & Women’s/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA
| | - RJ Rizzo
- Division of Cardiac Surgery, Brigham & Women’s/Cape Cod Hospital, Harvard Medical School, Boston, MA, USA
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Zhai B, Sun XY. Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients. World J Gastroenterol 2013; 19:3371-3374. [PMID: 23801828 PMCID: PMC3683674 DOI: 10.3748/wjg.v19.i22.3371] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 04/26/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.
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Effects of circuit residual volume salvage reinfusion on the postoperative clinical outcome for pediatric patients undergoing cardiac surgery. Pediatr Cardiol 2013; 34:1088-93. [PMID: 23239310 DOI: 10.1007/s00246-012-0606-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 11/29/2012] [Indexed: 12/31/2022]
Abstract
This study aimed to evaluate the effects of washed cardiopulmonary (CPB) circuit residual blood reinfusion on the postoperative clinical outcome for pediatric patients undergoing cardiac surgery. A total of 309 consecutive Chinese cardiac patients receiving CPB between October 2010 and April 2011 were prospectively analyzed. For 217 patients, CPB circuit residual blood was reinfused after the cell-saving procedure [cell-salvage group (CS)]. The remaining 92 patients were directly transfused with allogenic red blood cells (RBCs) after their operation [control group (CON)]. Assessment included perioperative transfusion of RBCs, postoperative hematocrit (HCT), chest tube drainage during the first 24 h after the operation, intrahospital mortality, respiratory morbidity, and renal dysfunction. The two groups were well matched in terms of demographics, CPB data, and complexity of surgical procedure. The patients in the CS group had a significantly higher HCT level postoperatively (p = 0.018) and a less allogenic RBCs transfusion (p = 0.000). The two groups did not differ in terms of chest tube drainage during the first 24 h postoperatively, intrahospital mortality, or respiratory morbidity. The incidence of serum creatinine (≥ 2-folds) during the first 72 h after the operation was significantly lower in the CS group (2.3 %) than in the CON group (8.7 %) (p = 0.010). Reinfusion of washed CPB circuit residual blood significantly raised the postoperative HCT level, reduced the allogeneic blood transfusion, decreased the incidence of early postoperative renal dysfunction, and did not increase the chest tube drainage after the operation in pediatric cardiac surgery.
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Paparella D, Scrascia G, Rotunno C, Marraudino N, Guida P, De Palo M, Rubino G, Cappabianca G. A Biocompatible Cardiopulmonary Bypass Strategy to Reduce Hemostatic and Inflammatory Alterations: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2012; 26:557-62. [DOI: 10.1053/j.jvca.2012.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Indexed: 11/11/2022]
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