The impact of bowl size, program setup, and blood hematocrit on the performance of a discontinuous autotransfusion system

Seyfried, Timo; Gruber, Michael; Streithoff, Fabian; Mandle, Robert J.; Pawlik, Michael; Busse, Hendrik; Hansen, Ernil

doi:10.1111/trf.13954

Cited by 7 publications

(13 citation statements)

References 22 publications

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“…Plasma from the patient is effectively removed during the processing of blood with CS. 21 Plasma contains platelets with direct antimicrobial activity, as they are activated to release peptides in response to trauma or mediators of inflammation, 22 for this reason pure platelet rich plasma is applied topically, for instance in oral surgery. 23 Plasma of cardiac surgical patients contains, as a result of the inflammatory response caused by surgery and CPB, pro-and anti-inflammatory enzymes and cytokines, such as interleukines, tumor necrosis factor, myeloperoxidase, elastase and complement factors.…”

Section: Discussionmentioning

confidence: 99%

Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

Klarenbosch

Heuvel

Oeveren³

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: Primary outcome was the risk for infections after cell salvage in cardiac surgery. Design: Data of a randomized controlled trial on cell salvage and filter use (ISRCTN58333401). Setting: Six cardiac surgery centers in the Netherlands. Participants: All 716 patients undergoing elective coronary artery bypass grafting, valve surgery, or combined procedures over a 4-year period who completed the trial. Interventions: Postoperative infection data were assessed according to Centre of Disease Control and Prevention/National Healthcare Safety Network surveillance definitions. Measurements and Main Results: Fifty-eight (15.9%) patients with cell salvage had infections, compared with 46 (13.1%) control patients. Mediation analysis was performed to estimate the direct effect of cell salvage on infections (OR 2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic transfusion and processed cell salvage blood on infections. Correction for confounders, including age, seks and body mass index was performed. Allogeneic transfusion had a direct effect on infections (OR = 2.082 [1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR = 0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p < 0.001), but a negative direct effect of processed cell salvage blood (1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there was a positive direct effect of cell salvage on the amount of processed blood. Conclusions: Cell salvage was directly associated with higher infection rates, but this direct effect was almost completely eliminated by its indirect protective effect through reduced allogeneic blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

Klarenbosch

Heuvel

Oeveren³

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Albumin is confirmed to best represent plasma elimination, while PFH and potassium show markedly lower values and wider variation. Calculation of their washout is obscured by the fact that their concentration decreases during the wash phase but concomitantly increases with some haemolysis occurring during the process . Heparin results overestimate plasma elimination due to additional removal by adsorption to cells and artificial surfaces .…”

Section: Discussionmentioning

confidence: 99%

“…Calculation of their washout is obscured by the fact that their concentration decreases during the wash phase but concomitantly increases with some haemolysis occurring during the process . Heparin results overestimate plasma elimination due to additional removal by adsorption to cells and artificial surfaces . Plasma elimination was slightly decreased for the 225‐ml bowl, but increased for the smaller bowls (compare Tables.…”

Section: Discussionmentioning

confidence: 99%

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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“…Clinical validation of the Sorin Xtra has shown the consistency of its hematocrit sensors and PRC product. 12,13 Fresenius CATS *plus The CATS *plus device was the original cell salvage system from Fresenius that was developed to maximize blood collection for all sized patients ( Figure 2). The CATS *plus is a centrifugal system that utilizes a continuous process for an autotransfusion product.…”

Section: Sorin Xtramentioning

confidence: 99%

“…Clinical validation of the Sorin Xtra has shown the consistency of its hematocrit sensors and PRC product. 12,13…”

Section: Introductionmentioning

confidence: 99%

Comparison of three autotransfusion devices for utilization in the pediatric population

et al. 2020

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Introduction: A device that may help attenuate the amount of homologous blood product given to pediatric cardiac surgical patients is the autotransfusion device. Three separate autotransfusion devices were selected for evaluation. The Sorin Xtra, Fresenius Continuous Autotransfusion System Plus (CATS*plus), and the Fresenius Continuous Autotransfusion System Smart (CATSmart) were evaluated based on the mechanical processes of each device, hematocrit value of the salvaged packed red cell product, time of processing, and the advantageous accessories with each device. Methods: Each of the autotransfusion devices were used to collect salvageable blood from the surgical field as well as to process residual blood from the cardiopulmonary bypass circuit after decannulation. The cell salvage process was performed in accordance with the manufacturer’s instructions for use and the recommended settings for processing and washing. The Sorin Xtra device had the 55 mL bowl set up for all cases, while the Fresenius continuous autotransfusion systems utilized the standard disposable for each device. Results: Each cell salvage device was employed during 30 pediatric cardiac surgery procedures, and data for each device, was broken down into four groups based on patient weight (0-10, 10-20, 20-40, and >40 kg). For all patient sizes, the Sorin Xtra tended to produce the greatest volume of cell saver product (55-825 mL) as compared to the CATS*plus and CATSmart devices (7-550 mL and 0-860 mL, respectively). The Continuous Autotransfusion System Smart tended to produce the highest hematocrit product, ranging from 44 to 81%. Discussion: Through this evaluation, it was determined the continuous autotransfusion systems provided the highest hematocrit with the lowest recovered packed red cell volume, while the Sorin Xtra packed red cell product showed to have a lower hematocrit with a larger packed red cell volume. Each device proved effective within our pediatric population.

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The impact of bowl size, program setup, and blood hematocrit on the performance of a discontinuous autotransfusion system

Cited by 7 publications

References 22 publications

Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

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

Comparison of three autotransfusion devices for utilization in the pediatric population

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