Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery

Abstract

Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):183-9 Silva LLM, et al. -Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery RBCCV 44205-1456 DOI: 10.5935/1678 Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery Impacto da transfusão autóloga no uso de concentrado de hemácias em cirurgias de revascularização do miocárdio INTRODUCTIONCardiovascular diseases are the leading causes of mortality not only in Brazil but also throughout the world [1,2], with acute myocardial infarction (AMI) being the main cause of death. The AMI surgical treatment through coronary artery bypass grafting surgery is an usual procedure, which is frequently associated with cardiopulmonary bypass (CPB) and high rates of homologous blood transfusion, varying from 40 to 90% in most publications [3][4][5]. Transfusion therapy is associated with several unfavorable outcomes, such as renal dysfunction, cardiac, neurological and immunological complications, among others [6].There is no consensus regarding an ideal value of hemoglobin or hematocrit which suggests transfusion in cardiac surgeries. The American Society of Anesthesiologists (ASA) recommends that pRBC transfusion in patients with serum level of hemoglobin between 6 and 10 g/dL be based on the risk of developing complications or organic lesion by inappropriate oxygenation [7]. The latest consensus concerning perioperative transfusion in cardiac surgery identified six variables as being important risk indicators of pRBC transfusion: old age, small total amount of red blood cells (anemia or small body size), use of antiplatelet or antithrombotic drugs, reoperation or complex procedures, emergency procedures and non-cardiac comorbidity. This same study stated, with a level A of evidence (class I), that all measures of pre and perioperative blood conservation must be taken into this group of patients, since they correspond to the greatest part of hemocomponent transfusions [8].Among mechanical strategies to reduce the necessity of homologous pRBC transfusion, we find the so-called Cell Saver (CS). It is a specialists' consensual opinion (level C of evidence and class IIb recommendation) that the use of autologous blood transfusion through mechanisms such as Cell Saver is reasonable, during surgeries with cardiopulmonary bypass [8]. However, there are few studies related to the impact of this practice on the real necessity of pRBC transfusion in cardiac surgeries with CPB, especially in coronary artery bypass grafting surgeries. The present study aims to evaluate the impact of Cell Saver on the necessity of pRBC use in coronary artery bypass grafting surgeries associated with miniCPB which were carried out at the University Hospital of Santa Maria (HUSM). METHODSWe carried out a retrospective cross-sectional study in patients who had their health care provided by the Division of Cardiac Surgery of HUSM, undergoing CABG ...

Comparison of two technics of extracorporeal circulation (Conventional and Mini ECC), in the trans and post-operative periods of cardiac surgery

“…Another option found to the problems of CPB was to minimize the volume of the infusion, with the miniaturization of the cardiopulmonary bypass (MCPB). Afterwards, several studies published comparing the CPB with off pump surgery and the MCPB, finding lower presence of hemodilution, coagulopathy [ 21 ] need for transfusion of red blood cells [ 22 - 27 ] and lower systemic inflammatory reaction in the surgery without CPB and MCPB in relation to the CPB [ 28 ] . It was also observed higher hemoglobin levels in MCPB than in CPB [ 26 ] .…”

Diminuição Do Uso De Bolsas De Sangue Em Cirurgias Cardiovasculares Pelo Uso Da Recuperação Intraoperatória De Células

“…O estudo randomizado parcialmente duplo cego feito por Vermeijden et al (2015) Uma pesquisa transversal brasileira realizada por Silva et al (2013) avaliou o uso de CH em pacientes que realizaram cirurgias de revascularização do miocárdio. A amostra foi dividida em 44 pacientes no grupo controle e 43 que utilizaram autotransfusão de hemácias com hemoconcentração e uso de miniCEC.…”