Autologous blood salvage in cardiac surgery: clinical evaluation, efficacy and levels of residual heparin

Vieira, Sérgio Domingos; Perini, Fernanda da Cunha Vieira; Sousa, Luiz; Buffolo, Ênio; Chaccur, Paulo; Arrais, Magaly; Jatene, Fábio Biscegli

doi:10.1016/j.htct.2019.08.005

Cited by 9 publications

(8 citation statements)

References 33 publications

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“…Several studies compare autotransfusion devices as to the processing quality after shed blood anticoagulation with UFH. They show that residual UFH levels in the processed RBC are quantitatively (although not immunologically) and hemostaseologically insignificant, and do not increase the postoperative bleeding risk 4,24 . To the authors' knowledge, and despite several adverse event reports, there is no controlled randomized study comparing clinical outcomes after use of UFH versus ACDA anticoagulant for autologous RBC salvage.…”

Section: Discussionmentioning

confidence: 96%

“…It is also traditionally linked to increased morbidity and mortality. [3][4][5] In cardiac surgery, the goals of patient blood management are to preserve hemostatic potential and minimize net perioperative blood loss. Consistent with current societal guidelines, the perioperative use of autotransfusion devices plays an important role, since it reduces the risk of allogeneic blood transfusion by a relative 23%.…”

Section: Introductionmentioning

confidence: 99%

“…Exposure to allogeneic red blood cells (RBC) is known to be independently associated with infection and with immunological and anaphylactic reactions. It is also traditionally linked to increased morbidity and mortality 3–5 …”

Section: Introductionmentioning

confidence: 99%

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Acid citrate dextrose formula A versus unfractionated heparin for anticoagulation of salvaged red blood cells in cardiac surgery

Erdoes

Stein

Eberle

et al. 2022

Journal of Cardiac Surgery

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Red blood cell salvage plays an important role in reducing the use of allogeneic blood transfusion during cardiac surgery. While there is consensus as to the benefit of employing cell salvage systems, there are no clear recommendations on the anticoagulant used for salvaged blood. In eight patients undergoing elective cardiac surgery at our university hospital's cardiovascular center, the authors describe hemodynamic effects of salvaged autologous blood transfusion when either unfractionated heparin or acid citrate dextrose formula A was used as the anticoagulant. Mean arterial pressure, heart rate, central venous pressure and acid–base status of the autologous red blood cell concentrate were compared between patients receiving autologous blood anticoagulated with acid citrate dextrose formula A versus unfractionated heparin. A clinically relevant decrease in mean arterial pressure (median change, − 19 mmHg [min −29; max −1] and marked acidosis [group median <6.30 [<6.30; 6.49] was observed in group acid citrate dextrose formula A. Acid citrate dextrose formula A anticoagulant for autologous red blood cell salvage has the potential to cause major adverse hemodynamic events during free‐flowing re‐transfusion of autologous red blood cell concentrate. Acute ionized hypocalcemia and acidemia may ensue from residual citrate in the supernatant of red blood cell concentrate reconstituted in unbuffered saline.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Acid citrate dextrose formula A versus unfractionated heparin for anticoagulation of salvaged red blood cells in cardiac surgery

Erdoes

Stein

Eberle

et al. 2022

Journal of Cardiac Surgery

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“…Patients with only TKA will have four times higher risk for PA (Table 5) if their weight is ≤73 kg and blood salvaged > 125 mL. Vieira et al [31] have shown that ICS device has a high recovery rate of RBC and high percentage of eliminating residual heparin, plasma proteins, albumins, and platelets. In procedures with ICS, the salvaged component is RBC only, so patients with RBC salvaged volume > 125 mL can have significant intraoperative loss of platelets and coagulation factors.…”

Section: Discussionmentioning

confidence: 99%

Using of Intraoperative Cell Salvage and Tranexamic Acid as Protective Factor for Postoperative Anemia Appearance in Patients with Total Hip or Knee Arthroplasty

2021

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(1) Background: The purpose of this study was to investigate intraoperative pharmacological and nonpharmacological methods and techniques in reducing blood loss in patients following total hip or knee arthroplasty. (2) Methods: A retrospective cross-sectional study was conducted in patients undergoing TKA or THA surgery, electively performed at the General Hospital Valjevo, Valjevo, Serbia, in 2014 when the principles of patient blood management (PBM) were not applied at all or in part, and in 2019 when PBM principles were applied as standard. (3) Results: This study includes 197 patients, of whom 83.8% developed postoperative anemia (PA defined by haemoglobin < 12 g/dL in both sexes). Using multivariate logistic regression and ROC curve analysis, it was shown that the use of tranexamic acid (TXA) with intraoperative cell salvage (ICS) in patients without preoperative anemia reduced the incidence of PA (odds ratio = 0.081). (4) Conclusions: Preoperative diagnosis and treatment of anemia are necessary in orthopedic patients since the use of TXA with ICS strongly reduces PA in patients without preoperative anemia.

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“…However, many studies suggest that cell salvage is associated with a decreased proportion of patients exposed to allogeneic RBC transfusions as an individual measure in a comprehensive PBM programme. [409][410][411][412][413][414] Although autologous platelet-rich plasmapheresis has been proposed as a blood conservation technique in complex cardiovascular surgery, whether it can improve clinical outcomes remains unclear. [415][416][417] The indications for autologous platelet-rich plasmapheresis require further study, particularly whether it is beneficial to lowrisk patients.…”

Section: Cell Salvagementioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Autologous blood salvage in cardiac surgery: clinical evaluation, efficacy and levels of residual heparin

Cited by 9 publications

References 33 publications

Acid citrate dextrose formula A versus unfractionated heparin for anticoagulation of salvaged red blood cells in cardiac surgery

Acid citrate dextrose formula A versus unfractionated heparin for anticoagulation of salvaged red blood cells in cardiac surgery

Using of Intraoperative Cell Salvage and Tranexamic Acid as Protective Factor for Postoperative Anemia Appearance in Patients with Total Hip or Knee Arthroplasty

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

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