Cell Salvage Device Research Articles

Effectiveness of intravenous tranexamic acid administration in managing perioperative blood loss in patients undergoing spine surgery: a systematic review

Review question/objective Is the intravenous administration of tranexamic acid (TXA) effective in the management of blood loss during the perioperative phase of spine surgery? The objective of this review is to identify the effectiveness of intravenous TXA administration in managing perioperative blood loss in patients undergoing spine surgery. Inclusion criteria Types of participants This review will consider studies that include patients undergoing any type of spine surgery who received intravenous TXA and all patients with comorbidities. There was no restriction on the age of the patients because the initiation and process of blood clotting and fibrinolysis does not discriminate between different age groups. There is no restriction on the age of these patients. Patients with coagulopathies or those receiving preoperative anticoagulant therapy will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the effectiveness of intravenous TXA administration on perioperative blood loss on all patients undergoing spine surgery. The administration of TXA will be compared to either patients receiving no TXA or a placebo of saline as reported. Studies comparing TXA to other antifibrinolytics will be excluded. Types of outcomes This review will consider studies that include the following outcome measures: intraoperative and postoperative blood loss collectively referred to as perioperative blood loss. The intraoperative blood loss will be measured by weighing surgical sponges, measuring the volume of blood collected in suction canisters and subtracting the irrigation fluid, and cell salvage devices and reported as estimated blood loss (EBL). Postoperative blood loss is measured from the volume of blood collected in the drainage bag or collecting reservoir. A secondary outcome to be measured will be the intravenous loading and maintenance dose of TXA administered to patients undergoing spine surgery

Utility of cell salvage in women undergoing abdominal myomectomy

We examined the use and cost of autologous blood cell salvage in women who undergo abdominal myomectomy. Patients who underwent abdominal myomectomy from 2007-2011 were identified. Use of the cell salvage system and reinfusion of autologous blood in women who had the system set-up were analyzed. Cost was examined by directly reported data. We identified 607 patients who underwent abdominal myomectomy. Four hundred twenty-five women (70%) had the set-up of the cell salvage system. Cell-salvaged blood was processed and reinfused into 85 of these subjects (20%). In a multivariable model, performance of myomectomy by a gynecologic-specific surgeon (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.28-3.59), >5 myomas (OR, 2.49; 95% CI, 1.27-4.89), and larger uterine size statistically were associated significantly with cell-salvage device set-up. Conversely, having a reproductive-endocrinology-infertility specialist as the surgeon was associated with a significant reduction in cell-salvage system set-up (OR, 0.37; 95% CI, 0.21-0.66). For the women who had cell-salvage system set-up, uterine size of >15-19 weeks of gestation (OR, 3.22; 95% CI, 1.56-8.95) or ≥20 weeks of gestation (OR, 4.62; 95% CI, 1.45-14.73), operating time of >120 minutes (OR, 3.98; 95% CI, 1.70-9.29), and intraoperative blood loss of >1000 mL (OR, 26.31; 95% CI, 10.49-65.99) were associated significantly with a higher incidence of reinfusion of cell-salvaged blood. The routine use of cell salvage in women who undergo abdominal myomectomy does not appear to be warranted. Cell-salvage set-up appears to be cost-effective only when reinfused, but clinical characteristics cannot predict accurately which women will require reinfusion of cell-salvaged blood.

A case of placenta percreta with massive hemorrhage during cesarean section

We describe a case of a 39-year-old woman diagnosed with placenta percreta complicated by massive hemorrhage during a cesarean section. At 27 weeks of gestation, she underwent an emergency cesarean section under general anesthesia for vaginal bleeding and an intrauterine infection. Soon after delivery, a massive hemorrhage was encountered while attempting to separate the placenta percreta from the bladder wall. Although total abdominal hysterectomy and partial cystectomy were performed, massive hemorrhaging persisted. Bleeding was finally controlled following bilateral internal iliac artery embolization. We used a cell salvage device and a rapid infuser for hemodynamics stabilization. Total blood loss was 47,000 mL, and anesthesia time was 12 h and 47 min. The patient was discharged on the 32(nd) postoperative day without major complications. Placenta accreta can be associated with life-threatening hemorrhage and it is vital to plan accordingly preoperatively.

A laboratory study of the effects of processing blood through a cell salvage device and leucocyte depletion filter on levels of pro‐inflammatory cytokines and bradykinin

We investigated changes in concentrations of interleukin-1β, interleukin-6, tumour necrosis factor-α and bradykinin in blood during passage through a cell salvage device and a leucocyte depletion filter, with or without application of subatmospheric pressure across the filter. Blood samples from 19 healthy women undergoing scheduled caesarean section showed concentrations of cytokines and bradykinin in blood filtered under gravity flow that were equal to or significantly lower than those of pre-operative venous blood samples. They were also significantly lower than that in postoperative orthopaedic shed blood, which is commonly reinfused after orthopaedic surgery. A minority of samples taken from blood that had been filtered using subatmospheric pressure showed raised interleukin-6 concentrations. We suggest that use of a leucocyte depletion filter for cell-salvaged blood with gravity flow is likely to be safe with regard to concentrations of cytokines and bradykinin. However, this may not hold true for the filter used with subatmospheric pressure. If transfusion of salvaged blood using a leucocyte depletion filter seems to induce hypotension, elevation of interleukin-6 should be suspected.

Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery

Estimates of blood loss in the operating room are typically performed as a visual assessment by providers, despite multiple studies showing this to be inaccurate. Use of a less subjective measurement of blood loss such as direct measurement of the hemoglobin (Hb) mass lost from the surgical field may better quantify surgical bleeding. The objective of this investigation was to compare anesthesiologist estimates of intraoperative blood loss with measured Hb loss. Sixty patients undergoing posterior spine surgery were enrolled in a prospective, randomized trial comparing intraoperative blood loss using unipolar cautery alone or with use of a bipolar tissue sealant device. Hb concentration and fluid volume were measured from all surgical sponges, suction canisters, and the cell salvage device. Using the volume and concentration of Hb from each solution allowed calculation of Hb mass, which was converted into volume of blood lost and compared with estimates of blood loss documented by the anesthesia team. A single-sample t test of no difference was used to compare estimated with measured blood loss. Mean estimated blood loss exceeded measured blood loss by 246 mL (860 mL vs. 614 mL, p < 0.0001). Estimated blood loss exceeded measured blood loss by 40% on average. The likely etiology of this discrepancy relates to the inability to visually determine Hb concentration of sanguineous solutions in suction canisters and surgical sponges. Ramifications of excessive bleeding estimates include unnecessary transfusion and overadministration of intravenous fluids, both of which may have deleterious effects.

In Vitro Analysis of Cell Salvage Blood Collection With a Laparoscopic Suction Device

Study ObjectiveTo determine whether cell salvage blood collection with a laparoscopic suction device is inferior to use of a traditional Yankauer suction device. DesignProspective, in vitro study. SettingAcademic teaching hospital. InterventionsIndividual units of donated packed red blood cells were diluted with normal saline solution to a hematocrit level of 21%. The blood was divided into 2 equal parts and then suctioned with either a laparoscopic suction device or a Yankauer plastic suction catheter tip connected to double-lumen cell salvage tubing with a diluted heparin drip and a vacuum pressure of 100 mm Hg. Collected blood was processed with a cell salvage device. Red blood cell volume was calculated by multiplying the hematocrit level by the total volume of blood product at the time of testing. Mean hemolysis indexes were compared between the laparoscopic and Yankauer method of blood collection by use of a 2-sample t test. Assuming a clinically acceptable limit of loss to be 7%, percent loss in red blood cell volume was tested with a 95% one-sided confidence limit to assess noninferiority. Measurements and ResultsThe mean hemolysis index was 43.33 with laparoscopic suction method and 34.67 with the Yankauer suction method. The mean difference was 8.67 and was not considered significant (p = .074). The percent loss in red blood cell volume after collection and cell salvage processing was 33.2% with the laparoscopic suction method and 29.57% with the Yankauer method. The mean difference was 3.63% and was within the acceptable 7% loss limit for noninferiority (p = .0278). ConclusionsLaparoscopic blood collection is not inferior to the standard Yankauer method for cell salvage collection.

Comparison of the Effects of Three Cell Saver Devices on Erythrocyte Function During Cardiopulmonary Bypass Procedure—A Pilot Study

Cell salvage devices are routinely used to process red blood cells (RBCs) shed during cardiac surgery. The purpose of this study was to evaluate three commercially available cell saver (CS) devices in terms of erythrocyte function and the quality of washed RBCs during cardiopulmonary bypass (CPB). Thirty patients undergoing CPB were randomly allocated to three CS devices: Group C (Cell Saver 5+; Haemonetics, n = 10), Group M (autolog; Medtronic, n = 10), and Group F (CATS; Fresenius HemoCare, n = 10). Blood samples were collected from reservoirs and transfusion bags. Reservoirs and washed RBCs were analyzed for erythrocyte aggregation index, deformation index (DI) and hematocrit viscosity, 2,3-diphosphoglycerate (2,3-DPG), hematocrit (Hct), hemoglobin (Hb), free Hb removal (ΔfHb), glucose (Glu), lactate (Lac), and blood urea nitrogen. After processing, Groups C (P = 0.026) and M (P = 0.032) had relatively higher erythrocyte DI compared with Group F. Group C had lower Δ2,3-DPG compared with Groups M (P = 0.001) and F (P = 0.001). Group F provided the maximum concentration of Hct (P = 0.021; 0.046) and Hb (P = 0.008; 0.013). In addition, Groups C (P = 0.035) and M (P = 0.038) had a higher removal of fHb (ΔfHb), differing significantly with Group F. In conclusion, CS devices use the same theory of centrifugation; however, based on different designs, the function of the washed erythrocyte and undesirable content removal efficiency differs widely from one device to another.

Surgical and anaesthetic management of anaemia: pros and cons of cell salvage devices

Autologous cell salvaged blood can be an effective way of minimising allogeneic blood transfusion in the elective and emergency surgical setting.The controlled use of such devices does require training and assessment of the operator's competence. There remains a reluctance to use in all surgical situations due to clinical objections about the likelihood of contamination of the blood by bacteria, malignant cells and fetal debris.A well led cell salvage service can ensure that quality assurance is achieved and provides a ready source of red cells for transfusion.

Autologous blood transfusion following red blood cell salvage for the management of blood loss in 3 dogs with hemoperitoneum

To describe the use of autologous transfusion using a red blood cell salvage device for the management of large volume hemorrhage in 3 dogs with hemoperitoneum. Three dogs were managed for large volume hemorrhage by autologous transfusion of red blood cells after cell salvage. In all cases, blood was salvaged from the abdominal cavity during surgery. The causes of hemorrhage included testicular arterial hemorrhage after castration, hepatic parenchymal hemorrhage following hepatic dissection for intrahepatic portosystemic shunt ligation, and intra-abdominal serosal hemorrhage associated with Angiostrongylus vasorum infection. In all cases, autologous transfusion was not associated with any identified complications and contributed to improved cardiovascular stability and packed cell volume. This case series is the first to describe the use of a semiautomated red blood cell salvage system for the clinical management of acute hemorrhage in dogs. This case series provides evidence that this procedure can be used safely and effectively for the management of clinical hemorrhage. On this basis, further veterinary evaluation can be justified.

A new mixture ratio of heparin for the cell salvage device

Adequate cell salvage for extracorporeal circulation requires anticoagulants such as heparin. The guideline of the American Association of Blood Banks recommends that 1 L of 0.9% saline containing 30,000 units of heparin should be mixed with aspirated blood at a ratio of 15 ml per 100 ml of collected blood [1]. If we maintain the ratio of heparinized saline to blood at 15 : 100, we need 2 vials of the Korean heparin product because its maximum amount of heparin in a vial is 25,000 units [2]. Therefore, we developed an alternative method of anticoagulation using only 1 vial of heparin. For extracorporeal circulation, the dose of heparin, which maintains an ACT of longer than 400-450 seconds, is 300-400 U/kg body weight [3]. To simplify calculation, we assume blood volume to be 70 ml/kg because the average blood volume of men is 75 ml/kg and that of women is 65 ml/kg. Since 70 ml of blood requires 300 units of heparin, 100 ml of blood requires 428 units of heparin. According to the guideline, 15 ml of heparinized saline contains 450 units of heparin because 1 L of heparinzed saline contains 30,000 units of heparin. If we mix 25,000 units of heparin with 1 L of 0.9% saline, we need 18 ml of heparinized saline to maintain the same amount of heparin because the new concentration of heparin is 25 units/ml. If we apply this method to a continuous autotransfusion system (CATS®), we should set the infusion rate at 234 drops per minute because 13 drops make 1 ml in the CATS. In summary, we can use 1 vial of heparin (25,000 units) to prevent coagulation in the cell salvage device using our mixture ratio.

Suction conditions for minimizing the production of free hemoglobin during blood salvage using an autotransfusion apparatus

BackgroundThree kinds of conditions should be considered to reduce free hemoglobin production using an autologous cell salvage device. They are the negative suction pressure, the size of suction tip, and the air contact during suction. We want to examine which condition is the most important factor to produce free hemoglobin.MethodsOne pack of red blood cell and one pack of fresh frozen plasma with the same blood type were mixed. They were aspirated based on the two suction pressure (-150 mmHg or -300 mmHg), three sizes of suction tips, and the two conditions of air contact, in which the suction tip was located in the surface of blood or in the middle of the blood. Seven ml sized EDTA tube was used to collect 5 ml blood. All the procedure repeated ten times. Free hemoglobin, total hemoglobin, and hematocrit were measured. Hemolysis ratio was calculated with following formula. Hemolysis ratio = (new free hemoglobin production) × (100-hematocrit) / (total hemoglobin).ResultsFree hemoglobin production and hemolysis ratio were increased when the suction tip was positioned in the surface than when it was in the middle of the blood. The pressure of negative suction and three kinds of the suction tips did not influence the production of free hemoglobin nor the hemolysis ratio.ConclusionsThe air contact is the most important factor to reduce hemolysis using autologous cell salvage device. Suction pressure or suction tip diameter have little influence to produce hemolysis.

Effects of Modified Ultrafiltration on Coagulation as Measured by the Thromboelastograph

Hemodilution during cardiopulmonary bypass (CPB) continues to be a cause of morbidity associated with coagulation dysfunction, bleeding, and allogeneic blood transfusion. Clot formation and strength have been shown to impact bleeding and transfusions. Strategies to reduce hemodilution may be negated based on the course of the cardiac procedure itself. Modified ultrafiltration (MUF) is commonly used in pediatric cardiac surgery; however, it is not well accepted in adult surgery. This study aimed to evaluate clot formation and strength, bleeding, and transfusions in adult subjects undergoing MUF. Nineteen subjects having primary coronary artery bypass, aortic, or mitral valve surgeries were recruited and randomized to having MUF (n= 10) or no-MUF (n= 9) performed after the termination of CPB. Five time points for data collection were designated: T1, baseline/induction; T2, termination CPB; T3, post-MUF; T4, post-protamine; T5, 24 hours postoperative. Subjects randomized to MUF had 1505 ± 15.8 mL of effluent removed, and no-MUF subjects had the CPB remnants processed with a cell salvage device. There was no statistical difference seen in 24-hour chest tube output, thromboelastograph values, or allogeneic transfusions at any time point between MUF and no-MUF subjects. There was a significant difference between MUF and no-MUF in the number of autologous cell salvage units processed (1.3 ± .48 vs. 2.9 ± .78,p= .0013) and end of procedure net fluid balance (+2003 ± 1211 vs. +4194 ± 1276 mL,p= .001), respectively. Estimated plasma loss from the cell salvage device was 477.6 mL greater in the no-MUF group. In primary adult cardiac procedures, MUF did not change coagulation values as measured by thromboelastography, number of allogeneic unit transfusions, or chest tube output at 24 hours postoperatively. There was a significant difference in autologous cell salvage units processed and end of procedure net fluid balance that benefited MUF subjects.

Blood conservation strategies in major orthopaedic surgery: efficacy, safety and European regulations

Several major orthopaedic surgical procedures may result in significant blood loss and the need for allogeneic blood transfusion (ABT). However, overall concerns about adverse effects of ABT have prompted the review of transfusion practice and the search for transfusion alternatives to decrease or avoid the use of ABT. These strategies include the correction of perioperative anaemia, pharmacological and non-pharmacologic measures to reduce blood loss, preoperative autologous blood donation and perioperative red blood cell salvage. We have reviewed the efficacy and safety of these strategies and where appropriate offer evidence-based recommendations on their use in orthopaedic surgery. We also reviewed the European regulations on ABT alternatives. Pharmacological alternatives need to be used with a total adherence to European regulations in their legal and off-label use. The administration and use of pharmacological agents to stimulate erythropoiesis or reduce blood loss needs to be within the context of attempting to use allogenic blood in a rational manner. As for autologous blood, European Directives cover preoperative autologous blood donation, but not its clinical use, and perioperative red blood cell salvage devices, but not the product yielded by them. Therefore, the development of quality standards and good practice guidelines for perioperative red blood cell salvage, as well as its inclusion in the haemovigilance programme, is urgently needed. Finally, it is noteworthy that some recommendations given for ABT alternatives are not supported by a high level of evidence and that the goal of performing major orthopaedic surgical procedures without the use of ABT may be better accomplished by combining several of these techniques within a defined algorithm.

An alternative approach for chest drainage after cardiac surgery: Redon drains

At the end of every cardiac procedure, two or three chest tubes (28F–32F) are typically placed in the mediastinum to continuously monitor postoperative blood loss and to prevent undesirable blood collection, especially in the pericardial space, which could potentially lead to cardiac tamponade. The chest tubes are connected to various drainage systems that use the underwater valve seal principle. Suction of about −20 cm H2O is usually applied. Here we present an alternative drainage system that provides distinct advantages over the commonly used systems. The drainage system consists of four or five Redon (B. Braun Melsungen AG, Melsungen, Germany) drains (2-mm inner diameter). Each drain is connected to a 600-mL reservoir with an applied suction of −800 mbar (816 cm H2O) (Figure 1). They are placed into the pericardial space (and pleural cavity, if needed) in the following sequence (Figure 2):1Drain 1 is positioned along the right heart border (right atrium), ending under the ascending aorta.2Drain 2 is positioned in front of the heart directly beneath the sternum.3Drain 3 is positioned along the diaphragmatic surface of the heart, ending over the lateral wall of the left ventricle.4Drain 4 is positioned in front of the heart (right ventricle), curving behind the pulmonary artery and ending in the sinus transversus.5Drain 5 (pleural, only if needed) is placed into the desired pleural space through a cauterized hole in the back wall of the pericardial sac, ending over the diaphragm.Figure 2Arrangement of the drains in the mediastinum.View Large Image Figure ViewerDownload Hi-res image Download (PPT) All drains exit the mediastinum through the abdominal fascia in the epigastric area. Drains are removed on the second postoperative day, being first disconnected from the reservoir to ensure that no continuous suction is applied during their removal. A total of 4297 cardiac procedures were performed between February 2002 and January 2007 at our institution. Redon drains were used for postoperative blood drainage in all cases (99.8%), regardless of the type of operation, with the only exceptions being 9 patients in whom it was not possible to control the coagulation disorder after weaning from cardiopulmonary bypass and who therefore required the use of a cell salvage device immediately after the procedure in the operating room and subsequently in the intensive care unit. Chest tubes (32F) were used in these 9 patients. The postoperative total blood losses at the time of Redon drain removal (usually on postoperative day 2) are summarized in Table 1. Postoperative bleeding complications for the cohort of 4297 patients in whom a Redon drainage system was used are listed in Table 2.TABLE 1The mean postoperative blood loss at the time of Redon drain removal (National Cardiac Surgery Registry 2002–2006)Type of procedureBlood loss (mL)CABG971.3Valves1057.6Thoracic aorta1153.9Redo procedures1497.6CABG, Coronary artery bypass grafting. Open table in a new tab TABLE 2Postoperative bleeding complications in patients in whom a Redon drainage system was used (n = 4297) (National Cardiac Surgery Registry 2002–2006)No. (%) of patientsReopening for bleeding119 (2.8%)Reopening for tamponade29 (0.7%) Open table in a new tab CABG, Coronary artery bypass grafting. Below, we summarize our experiences with the advantages and disadvantages of Redon drains relative to standard drainage approaches (using an underwater valve seal). 1The handling is more convenient. Once the drains are connected and checked for tightness (absence of air leaks), there is no need for further monitoring such as checking the water levels or the functioning of the water valve seal.2The Redon drainage system allows regions of bleeding to be detected. Each drain covers a specific area around the heart, facilitating the localization of any bleeding sources (eg, coronary suture line or left atrium suture line).3It decreases the risk of local tamponade. Positioning the drains over all the heart chambers, especially the right and left atria, decreases the risk of local tamponade.4It decreases the risk of coronary graft compression. The drains are thinner and more flexible, decreasing the risk of graft compression.5It maintains suction during patient transportation. There is no need for an external source of suction, which enables the suction to be maintained when transporting the patient from the operating room to the intensive care unit.6It is noiseless. It produces no bubbling sounds that are disturbing for both medical personnel and the patient.7It is cost-effective. The Redon drain system is five times cheaper than drainage using chest tubes. 1The Redon drain system is sensitive to air leaks. The presence of an air leak from the lung tissue will result in inadequate suction, requiring the system to be converted to the underwater drainage principle (external suction).2It cannot be used with a cell salvage system. In cases of profound bleeding resulting from coagulation disorder, the system cannot be used with a cell salvage device. Because of the distinct predominance of the advantages of the described system over its disadvantages, we highly recommend its broader use. Dr Gwozdziewicz

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery

Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

Intraoperative Blood Salvage: Fluid Replacement Calculations

Intraoperative blood salvage (IBS) devices are used as adjuncts to blood conservation in spinal surgical procedures of increasing duration, complexity, and total blood loss. We applied existing information about the performance and efficiency of IBS devices together with existing information regarding the distribution of crystalloids and colloids to provide clinicians with guidelines for the prediction of the total blood loss implications of a given volume of IBS return. We also developed guidelines for estimation of the appropriate replacement volumes for the acellular component of blood loss when replacement is undertaken with either isotonic-iso-oncotic colloid or isotonic crystalloid solutions. When average hematocrit during blood loss is between 25% and 30%, total blood loss will be 3.4-4.0 times the volume of the IBS recovery. When replacement is undertaken with colloids or crystalloids, the appropriate replacement volume will be approximately 2.5 and 8.0 (respectively) times the volume of the IBS recovery. These volumes may be larger than have been appreciated by some clinicians.

Cell Salvage in Trauma

SUMMARYTreatment of massive hemorrhage requires restoration of circulating blood volume to maintain oxygen delivery to the tissues. The maintenance of adequate cardiac output and restoration of intravascular volume can be achieved with non‐oxygen‐carrying volume expanders which may help restore blood pressure and maintain organ perfusion. Aims of treatment also include the avoidance of hypothermia and attempts to minimize the development of acidosis. The prompt use of cell salvage during early surgical intervention can help contribute autologous red cells to the total volume of red cells eventually transfused, thus minimizing allogeneic use. The autologous red cells have a higher 2,3‐diphosphoglycerate content than stored red cells and oxygen carriage may be better maintained in these earlier stages of resuscitation by the use of cell salvage devices.

Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: A randomized prospective trial

BackgroundWe prospectively evaluated a newly introduced minimal extracorporeal circulation system (Jostra MECC System; Jostra AG, Hirrlingen, Germany) for aortic valve surgery. MethodIn a prospective, randomized study, 100 patients underwent aortic valve replacement either with standard cardiopulmonary bypass (n = 50, group B) or with the MECC System (n = 50, group B). The myocardial protection and the left vent were identical for the two groups. The intrapericardial suction device was never used (only the cell salvage device was used) to reduce the air-blood contact area. ResultsNo significant differences were noted in patient characteristics and operative data between groups. Operative mortality (<30 days) was 2% for group A and 4% for group B (difference not significant). From the preoperative period to the postoperative period, the increase in C-reactive protein was significantly higher for group B (P < .001). The postoperative troponin I level was significantly lower in group A (mean 4.65 ± 2.9 μg/L at 24 hours) than in group B (8.2 ± 4.4 μg/L, P < .03). On the other hand, the MECC System was associated with platelet preservation. Renal function was better preserved and the neurologic event rate was significantly lower for the MECC group (P < .02). ConclusionThe MECC System is safe and allows aortic valve replacement under the most favorable conditions. The system is more biocompatible than standard cardiopulmonary bypass and provides a good postoperative biologic profile and good clinical results, particularly for high-risk patients.

Quality of Red Blood Cells Using Autotransfusion Devices: A Comparative Analysis

Cell salvage devices are routinely used to process and wash red blood cells (RBCs) shed during surgical interventions. Although the principle theory of cell saving is the same, the actual process to achieve this is very different from one device to another. The purpose of this study was to compare the quality of washed, concentrated RBC produced by five very different cell-saving devices, specifically the Cobe BRAT 2, Medtronic Sequestra 1000, Haemonetics Cell Saver 5, Medtronic Autolog, and the Fresenius CATS. Reservoir and washed red blood cells were analyzed for hematocrit (Hct), platelets (PLT), leukocytes (WBC), potassium (K+), heparin, plasma-free hemoglobin (PFH), RBC mass recovery and recovery rate. The Haemonetics and BRAT 2 had the highest RBC recovery. All devices adequately removed heparin and potassium. The Medtronic Autolog had the highest removal of platelets and PFH; whereas, the BRAT had the lowest. Although the Autolog had the highest leukocyte removal, leukocytes were not adequately washed out by any of the autotransfusion devices. In conclusion, although all cell- saving devices use the same theory of centrifugation, the actual quality of the washed RBC product differs widely from one device to another.

Mechanical methods of reducing blood transfusion in cardiac surgery: randomised controlled trial

Objective: To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery.Design: Randomised controlled trial.Setting:...