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Transfusion of Cell Saver Salvaged Blood in Neonates and Infants Undergoing Open Heart Surgery Significantly Reduces RBC and Coagulant Product Transfusions and Donor Exposures: Results of a Prospective, Randomized, Clinical Trial*

Cholette, Jill M. MD1; Powers, Karen S. MD1; Alfieris, George M. MD2; Angona, Ronald CCP2; Henrichs, Kelly F. MT(ASCP)3; Masel, Debra MT(ASCP)SBB3; Swartz, Michael F. PhD2; Daugherty, L. Eugene MD1; Belmont, Kevin CCP2; Blumberg, Neil MD3

Pediatric Critical Care Medicine: February 2013 - Volume 14 - Issue 2 - p 137–147
doi: 10.1097/PCC.0b013e31826e741c
Cardiac Intensive Care

Objective: To evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hrs, would decrease the number of postoperative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes.

Design: Prospective, randomized, controlled, clinical trial.

Setting: Pediatric cardiac intensive care unit.

Patients: Infants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass.

Interventions: Subjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hrs after collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups.

Measurements and Main Results: Children randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 vs. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hrs post-op (cell saver: 0.09 ± 0.45 vs. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 vs. control: 2.3 ± 4.8; p = 0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 vs. control: 1.1 ± 1.4; p = 0.07). There were no significant clinical outcome differences.

Conclusion: Cell saver blood can be safely stored at the bedside for immediate transfusion for 24 hrs after collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate postoperative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease postoperative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.

1 Department of Pediatrics, University of Rochester, Rochester, NY.

2 Department of Cardiac Surgery, University of Rochester, Rochester, NY.

3 Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY.

*See also p. 224.

The Fresinius Continuous AutoTransfusion System (CATS) was donated for use at the URMC by Terumo Corporation. This did not have any role in the study design, collection, analysis and/or in the decision to submit the manuscript for publication. There are no relationships with industry.

Dr. Blumberg has received funding from the National Institutes of Health. The remaining authors have not disclosed any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies