Intraoperative cell salvage is associated with reduced postoperative blood loss and transfusion requirements in cardiac surgery: a cohort study

Authors

  • Alexander B.A. Vonk,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Michael I. Meesters,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Robert P. Garnier,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Johannes W.A. Romijn,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Lerau J.M. van Barneveld,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Martijn W. Heymans,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Evert K. Jansen,

    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
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  • Christa Boer

    Corresponding author
    1. Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands
    2. Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands
    3. Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
    • Address reprint requests to: Christa Boer, PhD, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; e-mail: c.boer@vumc.nl.

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  • The Department of Cardio-thoracic Surgery of the VU University Medical Center, Amsterdam, the Netherlands, has been supported by unrestricted grants from Medtronic, Edwards Life Sciences, and St Jude Medical. Dr C. Boer was lecturer during two Medtronic Academia meetings.
  • This work was supported by the Department of Cardio-thoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands.

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.

Study Design and 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).

Conclusion

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.

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