Comparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery

Nakamura, Yoshito; Masuda, Mitsuharu; Toshima, Yoshihiro; Asou, Toshihide; Oe, Masahiro; Kinoshita, K; Kawachi, Yoshito; Tanaka, Jirou; Tokunaga, Kazutoshi

doi:10.1016/0003-4975(90)90879-b

Cited by 33 publications

(22 citation statements)

References 15 publications

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“…However, the total amount of free hemoglobin was well below acceptable limit in both the groups. Results of our study also confirm the findings of Nakamura et al 5 In their study in 1990, they also found significant hemolysis in both systems and observed that cell saver system was more efficient in removing the free hemoglobin.…”

Section: Discussionsupporting

confidence: 95%

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Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Garg

Malhotra

Desai

et al. 2015

Innovations�(Phila)

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Objective Cell Saver system is the method of choice for red blood cell salvage from the surgical field; however, cost is a limiting factor. We at our institute have devised a cost-effective version of dialyser-based autotransfusion system. We performed pretransfusion comparison of our autotransfusion system with conventional cell saver system. Methods A prospective randomized observational study was performed in 104 consecutive patients with coronary artery disease undergoing by off-pump coronary artery bypass grafting. Patients were divided into two groups. In the dialyser group (53 patients), blood from surgical field was salvaged by our dialyser-based system. In the cell saver group (51 patients), blood was salvaged by cell saver. In both groups, 20-mL sample from the salvaged blood was analyzed for hemoglobin, platelets, protein, albumin, free hemoglobin, osmotic fragility, and peripheral blood smear examination. Results Total hemoglobin salvaged was comparable in both groups (85% vs 76%). On peripheral smear, red blood cells were swollen, but morphology was preserved. Moreover, normal osmotic fragility suggested absence of any lethal damage to red blood cells in either group. Dialyser-based system was more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs 0%), and albumin (65% vs 0%). Total free hemoglobin was three times more in dialyser group but was well below recommended limits. Conclusions Dialyser-based system is economical, is equally efficacious in salvaging red blood cells, is more effective in salvaging platelets and proteins, and does not contain significant amount of free hemoglobin. Therefore, this salvaged blood can be safely transfused.

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Section: Discussionsupporting

confidence: 95%

“…5 Presently, it is routinely used in open heart surgeries for both continuous and modified ultrafiltration to remove free water and to reduce the inflammatory mediators. 6 However, it has never gained popularity for cell salvage in the perioperative period.…”

mentioning

confidence: 99%

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Garg

Malhotra

Desai

et al. 2015

Innovations�(Phila)

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“…Others showed slightly advantageous characteristics of ultrafiltration in the early postoperative period, but concluded that blood processing by cell salvage or ultrafiltration had no long-term benefits compared to direct infusion [7]. Direct comparisons of cell salvage and ultrafiltration indicated that cell salvage was associated with depletion of important plasma proteins, but this study was ex vivo and small in nature [27], whereas it has also been shown that cell salvage is more beneficial with respect to RBC concentration when compared to ultrafiltration [28]. Although the relevance of these older studies may be disputable, as bloodprocessing techniques significantly improved over the past decade, we found comparable results.…”

Section: Discussionmentioning

confidence: 69%

Residual blood processing by centrifugation, cell salvage or ultrafiltration in cardiac surgery

Vonk¹,

Muntajit²,

Bhagirath

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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The study compared the effects of three blood concentration techniques after cardiopulmonary bypass on clinical hemostatic and ex-vivo rheological parameters. Residual blood of patients undergoing elective cardiac surgery was processed by centrifugation, cell salvage or ultrafiltration, and retransfused (n = 17 per group). Study parameters included blood loss, (free) hemoglobin, hematocrit, fibrinogen and erythrocyte aggregation, deformability and 2,3-diphosphoglycerate content. Patient characteristics were similar between groups. Ultrafiltration was associated with the highest weight of the transfusion bag [649 ± 261 vs. 320 ± 134 g (centrifugation) and 391 ± 158 g (cell salvage); P < 0.01]. Cell salvage resulted in the lowest hemolysis levels in the transfusion bag. Retransfusion of cell saver blood induced the largest gain in postoperative patient hemoglobin levels when compared to centrifugation and ultrafiltration, and was associated with the largest increase in 2,3-diphosphoglycerate when compared to ultrafiltration (Δ2,3-diphosphoglycerate 1.34 ± 1.92 vs. -0.77 ± 1.56 mmol/l; P = 0.03). Cell salvage is superior with respect to postoperative hemoglobin gain and washout of free hemoglobin when compared to centrifugation or ultrafiltration.

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“…Ultrafiltration after CPB is another potential strategy to clean this residual blood and perhaps decrease postoperative bleeding. In contrast to cell saver, ultrafiltration may also reduce the activated inflammatory mediators contained in residual pump blood while maintaining levels of plasma proteins, PLTs, and coagulation factors . A recent meta‐analysis of randomized controlled trials by Boodhwani and colleagues showed a significant reduction in postoperative blood transfusions and hemorrhage with ultrafiltration.…”

Section: Discussionmentioning

confidence: 99%

Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial

et al. 2012

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Comparative study of cell saver and ultrafiltration nontransfusion in cardiac surgery

Cited by 33 publications

References 15 publications

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Residual blood processing by centrifugation, cell salvage or ultrafiltration in cardiac surgery

Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial

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