Efficacy of cell-saver in reducing homologous blood transfusions and inflammatory response during onpump cardiac surgery in low-risk patients: A prospective randomized study

Abstract

Materials and Methods:We included 63 patients and randomly assigned them into the control (Co; n=29) o cell saver (CS; n=34) group. We excluded high-risk surgical patients (defined as EuroSCORE>10%) and patients with high-risk for operative bleeding (defined according to SCA guidelines). All patients had cardiopulmonary bypass surgery. Five perioperative blood samples (arterial blood before operation, after the CBP bypass was finished, and 1-, 6-and 24-hours after operation) were obtained from each patient. ELISA was conducted to determine the levels of pro-inflammatory cytokines including interferon gamma (IF-γ), interleukin 6 (IL-6), . Results and Discussion: There was no difference between the two groups in the proportion of patients exposed to allogeneic blood transfusions (group CS:n=12; 40%), (group Co:n=13; 46,4%)(p=0,79). Preoperative haemoglobin<13,3 g/dl (RR=2,4 CI95%:1,3-4,7) and body surface area< 1,74 (RR=2,1 CI95%:1,2-3,9) were the main independent predictors of increased transfusion requirements in all patients. In the subgroup of patients with preoperative haemoglobin<13,3 g/dl, the use of cell saver did not reduce the need of allogenic blood transfusion. Significantly increased concentrations of cytokines IL-6, 8, and p40, were noted postoperatively in all patients, with peak serum levels at 1 hour. No differences in cytoquine serum levels were observed between the CS and the Co group at any postoperative measurement time. Conclusion(s):The routine use of cell salvage does not reduce the need of allogeneic blood transfusion in low-risk patients undergoing cardiac surgery. However, correction of preoperative haemoglobin levels may avoid unnecessary transfusions in these patients. Reinfusion of blood with cell saver does not contribute to a decrease in postoperative inflammatory response.48h postoperatively [1400(900/1750) vs. 900(550/1350), p=0.026]. There were no group differences in perioperative transfusion requirement or hemostatic therapy within the first 48 hours postoperatively. Conclusion(s): MUF increased platelet aggregation and reduced postoperative blood loss in a significant manner. Background and Goal of Study:Mediastinal blood reinfusion with cell saver is effective in reducing blood transfusions in patients at high-risk for operative bleeding during cardiac surgery. However, the use of this device in low-risk patients remains controversial. In addition, the influence of autotransfusion with cell-saving devices on postoperative systemic inflammatory response has not been clearly established. Therefore, we conducted a prospective, randomized controlled trial to examine the hypothesis that the use of cell salvage during routine cardiac surgery would reduce the proportion of patients exposed to allogeneic blood transfusion and the postoperative systemic inflammatory response. Background and Goal of Study:Glycine is a major inhibitory neurotransmitter, but also acts as obligatory coagonist at excitatory NMDA receptors. The synaptic glycine concentration is controlled by the glycine tran...