Postoperative autologous transfusion in cardiac surgery A prospective, randomised study

Abstract

To investigate the safety and efficacy of postoperative autologous blood transfusion (AT) using the Shiley hardshell venous reservoir, a prospective, randomised, controlled study was carried out in two matched groups of twenty patients undergoing elective coronary artery bypass surgery. The mean volume of shed mediastinal blood reinfused in the first 6 h postoperatively was 371.7 +/- 63.23 ml. Use of homologous blood was reduced from 760.5 +/- 108.37 ml in the control patients to 466.25 +/- 87.44 ml in the AT patients, a reduction of 38.7% (p less than 0.05). There was no statistically significant difference in the clinical outcome, overall blood loss, use of platelets, fresh frozen plasma and colloids, haematological indices, renal and hepatic functions, or clotting mechanism, although there was a reduction in the fibrinogen level in the patients who received AT (p less than 0.05). Mediastinal blood did not clot and was defibrinogenated. It contained significant levels of haemoglobin (8.175 +/- 0.506 g/dl), platelets (96.55 +/- 10.39 per mm3 10(3)), protein (42.5 +/- 1.13 g/l), calcium (2.385 +/- 0.054 mmol/l) and was well oxygenated (PO2 = 20.46 +/- 0.81 kPa). No patients developed bacteraemia or had any AT-related infections. We conclude that postoperative autologous transfusion using the Shiley hardshell venous reservoir is a safe and efficient method for reducing postoperative homologous blood requirement after coronary artery bypass surgery.

Transfusion Medicine — Blood Conservation

“…103,104 Prospective and controlled trials have reached disparate conclusions about the efficacy of postoperative recovery of blood from patients after cardiac surgery: at least three such studies demonstrated a lack of efficacy, [176][177][178] whereas at least two have reported a benefit. 179,180 The disparity in results may *There were no significant differences in the need for allogeneic blood transfusions between the groups assigned to acute normovolemic hemodilution and the groups assigned to autologous blood donation. †This group served as the control group.…”

Blood Transfusion and Blood Conservation: Cost and Utilization Issues

“…Postoperative autologous blood salvage and reinfusion is practiced widely, but not uniformly ; a recently-published survey of tertiary medical centers found that only 5 of 15 institutions salvaged cardiac surgery patients postoperatively; in these 5 centers, approximately 50% of the chest tube blood shed postoperatively was reinfused into patients undergoing primary, elective coronary bypass surgery (54). Prospective and controlled trials have disagreed over the efficacy of postoperative blood salvage in conserving blood in cardiac surgery patients; at least three such studies have demonstrated lack of efficacy (95)(96)(97), while at least two studies have shown benefit (98,99). In addition, uncontrolled reports of cardiac surgical programs that used a combination of intraand postoperative salvage techniques have shown a benefit (94,100,101).…”

Blood conservation in the intensive care unit

“…Because such blood is often diluted, partially hemolyzed, defibrinated, and may contain a high concentration of cytokines, the effectiveness of routine salvage techniques has been uncertain (10,(45)(46)(47)(48)(49). Selective use of salvage and autotransfusion in critically ill patients with very large postoperative recoverable blood loss may be effective at limiting the acute development of anemia and transfusion requirements (50,51). Acute normovolemic hemodilution describes the removal of whole blood from a patient immediately before a surgical procedure and simultaneous replacement of circulating volume with a crystalloid or colloidal solution (10).…”