Fat removal during cell salvage: a comparison of four different cell salvage devices

Seyfried, Timo; Haas, Lilith; Gruber, Michael; Breu, Anita; Loibl, Markus; Hansen, Ernil

doi:10.1111/trf.13035

Cited by 12 publications

(35 citation statements)

References 16 publications

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“…The filters were also changed frequently to obtain a maximal effect. It has been shown that additional filters may reduce the blood recovery rate . This was not the case in our study.…”

Section: Discussioncontrasting

confidence: 54%

Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery

et al. 2019

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BACKGROUND Several authors and manufacturers of cell salvage devices recommend additional filtering of processed blood before transfusion. There is no evidence to support this practice. Therefore, we compared the clinical outcome and biochemical effects of cell salvage with or without additional filtering. STUDY DESIGN AND METHODS The patients, scheduled for coronary artery bypass grafting, valve replacement, or combined procedures were part of our randomized multicenter factorial study of cell salvage and filter use on transfusion requirements (ISRCTN 58333401). They were randomized to intraoperative cell salvage or cell salvage plus additional WBC depletion filter. We compared the occurrence of major adverse events (combined death/stroke/myocardial infarction) as primary outcome and minor adverse events (renal function disturbances, infections, delirium), ventilation time, and length of stay in the intensive care unit and hospital. We also measured biochemical markers of organ injury and inflammation. RESULTS One hundred eighty‐nine patients had cell salvage, and 175 patients had cell salvage plus filter and completed the study. Demographic data, surgical procedures, and amount of salvaged blood were not different between the groups. There was no difference in the primary outcome with a risk of 6.3% (95% confidence interval [CI], 3.34–11.25) in the cell salvage plus filter group versus 5.8% (95% CI, 3.09–10.45) in the cell salvage group, a relative risk of 1.08 (95% CI, 0.48– 2.43]. There were no differences in minor adverse events and biochemical markers between the groups. CONCLUSION The routine use of an additional filter for transfusion of salvaged blood is unlikely to show important additional benefits.

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“…The filters were also changed frequently to obtain a maximal effect. It has been shown that additional filters may reduce the blood recovery rate . This was not the case in our study.…”

Section: Discussioncontrasting

confidence: 54%

Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery

et al. 2019

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“…Blood group‐matched donations (PRBC and FFP 1:1) were mixed and adjusted with saline solution (0·9% RICCA Chemical Company, Arlington TX), to a haematocrit of 10% to represent typical surgical blood pool concentration. Portions of 45 ml of blood and 5 ml of fat were mixed air‐free in two 50‐ml syringes connected by a three‐way stopcock and added to a blood volume to result in a final concentration of 1·25% fat, as previously described . Thorough mixing was achieved by forcing the blood–fat mixture between the syringes.…”

Section: Methodsmentioning

confidence: 99%

“…The amount of fat in blood samples before and after processing was measured by volumetric quantification as described elsewhere . In short, each blood sample was injected into two silicone‐bottom‐sealed Pasteur pipettes.…”

Section: Methodsmentioning

confidence: 99%

“…Cells and fluids are separated according to their specific densities, and lighter materials are removed by fluid flow, while the denser RBC accumulates in the bowl. Obviously, there exist other factors that in part prevent fat despite its very light density from leaving the separation chamber, both in continuous and discontinuous autotransfusion devices . In experiments with soya bean oil or with fat from human fat tissue, fat removal rates of just 70–80% have been observed for bowl‐based separation chambers, significantly lower than with the continuous C.A.T.S system .…”

Section: Introductionmentioning

confidence: 99%

“…Obviously, there exist other factors that in part prevent fat despite its very light density from leaving the separation chamber, both in continuous and discontinuous autotransfusion devices . In experiments with soya bean oil or with fat from human fat tissue, fat removal rates of just 70–80% have been observed for bowl‐based separation chambers, significantly lower than with the continuous C.A.T.S system . Further studies showed that fat removal can be increased by filtration, or by modifications in the process parameters and the program .…”

Section: Introductionmentioning

confidence: 99%

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A new approach for fat removal in a discontinuous autotransfusion device–concept and evaluation

et al. 2017

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Background Fat present during blood salvage in orthopaedic or cardiac surgery can pose a risk of fat embolism and should be eliminated before transfusion. Based on observations of central fat accumulation at the bottom of Latham bowls, a fat reduction program was developed using two volume displacements, where blood temporarily is removed and respun in the bowl to force the fat through the RBC sediment. Materials and MethodsPooled ABO-matched RBC and FFP were adjusted to a haematocrit of 10%, and human fat tissue added to a concentration of 1Á25 vol%. In six experiments, blood was processed with the new-generation cell salvage device CS Elite in a newly developed fat reduction program in bowls of three sizes. Volumetric quantification of fat was performed after centrifugation of blood samples in Pasteur pipettes. From volumes, haematocrits and the concentrations of fat, RBC recovery and fat elimination rates were calculated.Results Fat removal rates of 93Á2 -2Á8, 97Á0 -2Á1 and 99Á6 -0Á3% were observed with a 70-ml, 125-ml and 225-ml bowl, respectively, and even higher rates when removal rates were calculated one cycle. At the same time, high RBC recovery and plasma elimination rates were maintained, not significantly different to the default program mode.Conclusion Modifications in process parameters and sequence led to a fat reduction program that significantly improves fat removal with the Cell Saver Elite from 77Á4 -5Á1% in the default mode to an average of 98Á6 -1Á1%, yielding results equivalent to the continuous cell salvage system (C.A.T.S).

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Neurologic Complications of Fat Embolism Syndrome

Morales-Vidal

2019

Curr Neurol Neurosci Rep

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Fat removal during cell salvage: a comparison of four different cell salvage devices

Cited by 12 publications

References 16 publications

Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery

Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery

A new approach for fat removal in a discontinuous autotransfusion device–concept and evaluation

Neurologic Complications of Fat Embolism Syndrome

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