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Coagulation

The impact of intra-operative red cell salvage on allogeneic blood requirements following cardiac surgery: 090

Spackman, D.; Powroznyk, A.; Naughton, C.; Vroemen, J.; Morley, A.; Feneck, R. O.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 10-11

Introduction: The impact of cross infection screening and other factors have caused a large increase in the cost of allogeneic red cells (ARC). Many institutions have developed multi-modal strategies for reducing ARC requirements following cardiac surgery [1,2]. We recently introduced intraoperative cell salvage (ICS) for routine use in all adult cardiac surgery and examined the impact of ICS on blood product consumption, haemoglobin concentrations and coagulation parameters by way of a closed loop observational study.

Method: 108 consecutive patients (control group) undergoing elective cardiac surgery were studied and data collected on blood product use (intraoperative, in ITU and cumulative) and haemoglobin (Hb) concentration changes (pre-operatively, on ITU admission, 24 hours post-operatively and on discharge from hospital). ICS equipment was subsequently purchased and made available to all patients undergoing cardiac surgery. We studied the impact of this by repeating our original observations over a four-week period (n = 91; ICS group).

Results: ICS patients received an average of 8.8 mLkg−1 (SD = 3.6 mL kg−1) of processed autologous blood following cardio-pulmonary bypass (CPB). Table shows the number (%) of patients given ARC.

Table
Table:
No Caption available.

The mean Hb concentration on ITU admission was significantly higher in the ICS group (10.3gmdL−1 ± 1.63 vs. 9.1gm dL−1 ± 1.36; P < 0.001). ARC use was significantly lower in the ICS group (42%) compared to the control group (67%) during the first 24-hour period following surgery (P < 0.001), and the percentage of patients receiving no allogeneic blood prior to hospital discharge was 21% in the control group as compared to 34% in the ICS group (P = 0.06). In the ICS group the volume of cell salvaged blood given was significantly correlated with APTT (regression equation P = 0.018) and INR (regression equation P = 0.015) as measured on admission to ITU, but not with platelet count or fibrinogen concentration.

Conclusion: ICS significantly reduced the use of ARC in the early postoperative period following elective cardiac surgery. This was associated with significantly higher Hb concentrations on admission to ITU. The volume of ICS blood given correlated with APTT and INR abnormalities which may indicate a dilutional coagulopathy as a result of clotting factor clearance by the cell salvage process. Large volumes of ICS blood may be an indication for fresh frozen plasma.

References:

1 Kovesi T, Royston D. Pharmacological approaches to reducing allogeneic blood exposure. Vox Sang 2003; 84: 2-10. Review.
2 McGill N, O'Shaughnessy D, Pickering R, et al. Mechanical methods of reducing blood transfusion in cardiac surgery: randomised controlled trial. BMJ 2002; 324: 1299-1303.
© 2004 European Society of Anaesthesiology