A comparison of intra-operative cell-saving strategies upon immediate post-operative outcomes after CPB-assisted cardiac procedures

Abstract

Cardiotomy suction has been associated with adverse outcomes under routine conditions in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). We hypothesized that the routine use of a cell saver (CS) in place of the cardiotomy sucker would have no negative impact on transfusion rate (TR), chest tube drainage (CTD), ventilation time (VT) or intensive care unit length of stay (ICULOS) while avoiding the detrimental effects of cardiotomy suction. Retrospective data were collected from 69 patients where a cell saver was not used (NCS). Prospective data were collected from 219 patients who were followed after the implementation of an intra-operative cell saver. No significant increase in transfusion rate, chest tube drainage or ventilation time was found between the NCS group and the CS group. However, post-operative hemoglobin concentrations were significantly higher in the CS group (0.0001) and the CS group spent significantly less time in the ICU (p=0.018).

Keywords

cardiac surgery cardiopulmonary bypass cardiotomy suction cell saver chest tube drainage intensive care unit prospective retrospective transfusion ventilation time

Get full access to this article

View all access options for this article.

References

1 Westerberg M Gabel J Bengtsson A Sellgren J Eidem O Jeppsson A . Hemodynamic effects of cardiotomy suction blood . J Thorac Cardiovasc Surg 2006; 131(6): 1352 – 1357 .

2 Pierangeli A Masieri V Bruzzi F . Haemolysis during cardiopulmonary bypass: how to reduce the free haemoglobin by managing the suctioned blood separately . Perfusion 2001; 16(6): 519 – 524 .

3 Amand T Picemail J Blaffart F Larbuisson R Limet R Defraigne JO . Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit . Perfusion 2002; 17(2): 117 – 123 .

4 Lin TY Chen KM Lu CW Jean WH Horng FM Chu SH . Cell saver does not increase pro-inflammatory cytokine levels and expression of adhesive molecules in the salvaged blood of patients undergoing off-pump coronary artery surgery . Acta Aneasthesiol Taiwan 2005; 43(4): 211 – 215 .

5 Aldea GS Soltow LO Chandler WL . Limitation of thrombin generation, platelet activation, and inflammation by elimination of cardiotomy suction in patients undergoing coronary artery bypass grafting treated with heparin-bonded circuits . J Thorac Cardiovasc Surg 2002; 123(4): 742 – 755 .

6 Caguin F Carter MG . Fat embolization with cardiotomy with the use of cardiopulmonary bypass . J Thoracic and Cardiovasc Surg 1963; 46(5): 665 – 672 .

7 Aberg T Ronquist G Tyden H Ahlund P Bergstrom K . Release of adenylate kinase into cerebrospinal fluid during open-heart surgery and its relation to postoperative intellectual function . Lancet 1982; 1(8282): 1139 – 1142 .

8 Kincaid EH Jones TJ Stump DA . Processing scavenged blood with a cell saver reduces lipid microembolization . Ann Thorac Surg 2000; 70(4): 1296 – 1300 .

9 Siderys H Herod GT Halbrook H . A comparison of membrane and bubble oxygenation as used in cardiopulmonary bypass in patients. The importance of pericardial blood as a source of hemolysis . J Thorac Cardiovasc Surg 1975; 69(5): 708 – 712 .

10.

10 Pugsley W Klinger L Paschalis C Treasure T Harrison M Newman S . The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning . Stroke 1994; 25(7): 1393 – 1399 .

11.

11 Daane CR Golab HD Meeder JH Wijers MJ Bogers AJ . Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis, complement activation, postoperative blood loss and transfusion volume . Perfusion 2003; 18(2): 115 – 121 .

12.

12 Murphy GJ Allen SM Unsworth-White J . Safety and efficacy of perioperative cell salvage and autotransfusion after coronary artery bypass grafting: a randomized trial . Ann Thorac Surg 2004; 77(5): 1553 – 1559 .

13.

13 Niranjan G Asimakopoulos G Karagounis A Cockerill G Thompson M Chandrasekaran V . Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on versus off cardiopulmonary bypass: a randomised trial . Eur J Cardiothorac Surg 2006; 30(2): 271 – 277 .

14.

14 Fahrmeir L Tutz G . Multivariate statistical modeling based on generalized linear models. New York : Springer , 2001.

15.

15 Software SAS . Usage and reference. SAS Institute Inc., Version 9.1. Cary, NC, 2002.

16.

16 Holmes JH Connolly NC Paull DL . Magnitude of the inflammatory response to cardiopulmonary bypass and its relation to adverse clinical outcomes . Inflamm Res 2002; 51(12): 579 – 586 .

17.

17 Challa VR Moody DM Troost BT . Brain embolic phenomena associated with cardiopulmonary bypass . J Neurol Sci 1993; 117(1-2): 224 – 231 .

18.

18 Blauth C Smith P Newman S . Retinal microembolism and neuropsychological deficit following clinical cardiopulmonary bypass: comparison of a membrane and a bubble oxygenator. A preliminary communication . Eur J Cardiothorac Surg 1989; 3(2): 135 – 138 .

19.

19 Lilly KJ O’Gara PJ Treanor PR Crowley R . Heparin-bonded circuits without a cardiotomy: a description of a minimally invasive technique of cardiopulmonary bypass . Perfusion 2002; 17(2): 95 – 97 .

20.

20 Takayama H Soltow LO Chandler WL Vocelka CR Aldea GS . Does the type of surgery effect systemic response following cardiopulmonary bypass . J Card Surg 2007; 22(4): 307 – 313 .

21.

21 Appelblad M Gunnar E . Fat contamination of pericardial suction blood and its influence on in vitro capillary-pore flow properties in patients undergoing routine coronary artery bypass grafting . J Thorac Cardiovasc Surg 2002; 124(2): 377 – 386 .

22.

22 Brooker RF Brown WR Moody DM . Cardiotomy suction: a major source of brain lipid emboli during cardiopulmonary bypass . Ann Thorac Surg 1998; 65(6): 1651 – 1655 .

23.

23 Gerbode F Osborn JJ Melrose DG . Extracorporeal circulation in intracardiac surgery: a comparison between two heart-lung machines . Lancet 1958; 2(7041): 284 – 286 .

24.

24 Challa VR Lovell MA Moody DM Brown WR Reboussin DM Markesbery WR . Laser microprobe mass spectrometric study of aluminum and silicon in brain emboli related to cardiac surgery . J Neuropathol Exp Neurol 1998; 57(2): 140 – 147 .

25.

25 Brown WR Moody DM Challa VR . Cerebral fat emboli from cardiopulmonary bypass . J Neuropathol Exp Neurol 1999; 58(2): 109 – 119 .

26.

26 Ajzan A Modine T Punjabi P Ganeshalingam K Philips G Gourlay T . Quantification of fat mobilization in patients undergoing coronary artery revascularization using off-pump and on-pump techniques . J Extra Corpor Technol 2006; 38(2): 116 – 121 .

27.

27 Potger KC McMillan D Connolly T Southwell J Dando H O’Shaughnessy K . Coronary artery bypass grafting: an off-pump versus on-pump review . J Extra Corpor Tech 2002; 34(4): 260 – 266 .

28.

28 Stroobant N Van Nooten G Van Belleghem Y . Short-term and long-term neurocognitive outcome in on-pump versus off-pump CABG . Eur J Cardiothorac Surg 2002; 22(4): 559 – 564 .

29.

29 Ferraris VA Ferraris SP Saha SP . Perioperative blood transfusion and blood conservation in cardiac surgery: The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Clinical Practice Guideline . Ann Thorac Surg 2007; 83(5 Suppl): S27 – S86 .

30.

30 Liu B Belboub A Larsson S Roberts D . Factors influencing haemostasis and blood transfusion in cardiac surgery . Perfusion 1996; 11(2): 131 – 143 .