Perioperative Cell Salvage Research Articles

Safety and efficacy of perioperative cell salvage and autotransfusion after coronary artery bypass grafting: a randomized trial

Background The aim of this study was to ascertain whether cell salvage and autotransfusion after first time elective coronary artery bypass grafting is associated with a significant reduction in the use of homologous blood, a clinically significant derangement of postoperative clotting profiles, or an increased risk of postoperative bleeding. Methods Patients were randomized to autotransfusion (n = 98) receiving autotransfused washed blood from intraoperative cell salvage and postoperative mediastinal fluid cell salvage after coronary artery bypass surgery or control (n = 102) receiving stored homologous blood only after coronary artery bypass surgery. Results There was no statistical difference between the groups in terms of demographics, comorbidity, risk stratification, or operative details. Mean volume of blood autotransfused was 367 ± 113 mL. Patients in the autotransfusion group were significantly less likely to receive a homologous blood transfusion compared with controls (odds ratio 0.40, 95% confidence interval [CI] 0.22–0.71) and received significantly fewer units of blood per patient compared with controls (0.43 ± 1.5 vs 0.90 ± 2.0 U, p = 0.02). There was no difference between the groups in terms of postoperative blood loss, fluid requirements, blood product requirements, or in the incidence of adverse clinical events ( p = NS χ 2). Autotransfusion did not produce any significant derangement of thromboelastograph values or laboratory measures of clotting pathway function (prothrombin time, activated partial thromboplastin time, fibrinogen, and fibrinogen D-dimer levels) when compared with the effect of homologous blood transfusion ( p = NS, repeated measures analysis of variance [MANOVA]). Conclusions Autotransfusion is a safe and effective method of reducing the use of homologous bank blood after routine first time coronary artery bypass grafting.

Survey of the implementation of the recommendations in the Health Services Circular 1998/224 'Better Blood Transfusion'.

This report describes a questionnaire survey on the implementation of the recommendations of the Health Services Circular (HSC) 'Better Blood Transfusion' 1998/224 for improving transfusion practice. The survey was carried out to inform a second UK Chief Medical Officers' symposium on 'Better Blood Transfusion' in October 2001. Sixty-nine percent of hospitals where blood is transfused in England participated. The results show that, by 2001, most hospitals had established Hospital Transfusion Committees (HTCs), developed protocols for the process of transfusion and were participating in the Serious Hazards of Transfusion (SHOT) scheme. However, there was limited compliance with other recommendations, including the provision of training for staff involved in transfusion and information to patients, the development of protocols for the appropriate use of blood, the performance of audits of transfusion practice and the introduction of peri-operative cell salvage. The survey did not determine the reasons for this limited compliance. New initiatives including the issue of a further HSC on 'Better Blood Transfusion' are aimed at enabling hospitals to improve their transfusion practice in a more systematic way than that was found in the results of this survey.

A survey of blood transfusion practice in UK cardiac surgery units

Blood is expensive and carries risks. The theoretical risk of variant Creutzfeldt-Jakob disease and the consequent introduction of leucodepletion by UK blood services has significantly increased the cost of blood to the National Health Service. This is with a probable increase in demand because of waiting lists and no concurrent increase in donations. Cardiac surgery is a major user of blood. The use of guidelines and blood conservation techniques such as perioperative cell salvage may result in a reduction in blood use [1]. We do not have guidelines in our unit and have reviewed our blood use over the past 3 years. In the absence of good evidence from which to construct guidelines, we have surveyed UK cardiac surgery units on blood use and the presence of audit and guidelines in order to form an overview of current practice.

A risk-benefit assessment of aprotinin in cardiac surgical procedures.

Aprotinin, a naturally occurring serine protease inhibitor, has found widespread application during cardiac surgical procedures as a consequence of its ability to decrease blood loss and transfusion requirements. While its efficacy in a variety of clinical situations associated with increased risk of blood loss has been well established, at the same time, various complications including anaphylaxis, renal insufficiency, graft closure and arterial thromboses have been reported in association with aprotinin administration. In order to more fully evaluate the risks and benefits associated with aprotinin usage, this review first of all examines the hazards associated with transfusion of blood and blood products. Consideration is then given to various alternatives to allogeneic transfusion, including autologous predonation, acute normovolemic hemodilution, perioperative cell salvage and intraoperative plasma sequestration. A critique of other available pharmacological therapies, specifically desmopressin, aminocaproic acid and tranexamic acid, reviewing their modes of action, efficacy and associated complications, is then made. The role of aprotinin in cardiac surgery is then discussed and its pharmacology, including consideration of its antifibrinolytic, platelet preserving and anti-inflammatory effects is reviewed. Finally, an analysis of potential complications associated with aprotinin administration is undertaken. Issues involving its influence on specific measures of anticoagulation, namely partial thromboplastin time and activated clotting time, and issues relating to graft patency, hypothermic circulatory arrest, renal function, and allergic reactions are analysed and interpreted. In summary, this review concludes that most of the risks associated with aprotinin administration primarily involve inadequate anticoagulation and those of developing an allergic reaction, particularly upon aproptinin re-exposure. The benefits of aproptinin to decrease blood loss and transfusion requirements are confirmed, and there is evidence pointing to the intriguing possibility of a potential salutary effect on perioperative central nervous system complications.

Blood donor‐, apheresis‐, and transfusion‐related activities: results of the 1991 American Association of Blood Banks Institutional Membership Questionnaire

Approximately 2154 regional blood centers and hospital-based blood banks and transfusion services responded to the 1991 American Association of Blood Banks Institutional Membership Questionnaire that elicited data from 1990. Information from 2144 institutions was considered valid. Questionnaire topics were donor blood collections, hemapheresis, perioperative cell salvage, component usage, and transfusion-associated diseases. Institutional members reported collecting 9.3 million units, of which 90.9 percent were for allogeneic use in the community, 6.0 percent were for autologous use, and 3.1 percent were directed donations. The percentage of directed-donor units that were crossed over for allogeneic use (51%) was greater than the percentage of units transfused to the designated patient (49%). Only 12.5 percent of institutions reported obtaining specific consent for transfusion. Of the 15.4 million transfused blood components, 8.5 million were red cells, 4.1 million were platelets, 1.8 million were fresh-frozen plasma, and 0.9 million were cryoprecipitate. There were 1263 reported cases of transfusion-associated hepatitis. Approximately 44 percent of the patients who were tested proved positive for hepatitis B surface antigen, and 80 percent of the patients who were tested proved positive for antibody to hepatitis C. The questionnaire's aggregate results can be used to assess current patterns of blood donation and transfusion activities.