Rev Bras Cir Cardiovasc 2013;28(1):76- Abstract Introduction: The use of cell saver (CS) in cardiac surgery is proposed to reduce the use of units of packed red blood cells stored (UPRBC), which increases morbidity, mortality and causes inflammatory reactions.Objective: The objective is to evaluate whether the use of CS decreases the use UPRBC, is cost / effective and beneficial to the patient.Methods: In a prospective study, between November 2009 and October 2011, 100 consecutive patients who underwent cardiovascular surgery with CPB, hemodilution and hemofiltration, were enrolled. Patients were divided into group 1 (no CS) and 2 (CS). The criteria for the replacement of RBC were hemodynamic instability and hemoglobin (Hb) <7-8g/dl. Demographic data, as well as Hb and hematocrit, mediastinal drainage, number of URBC and CPB, ICU and hospital time, were analysed.Results: In groups 1 and 2 the average age was 64.1 and 60.6 years; predominantly male; the logistic EuroSCORE 10.3 and 9.4; mortality 2% and 4%. Group 2 had a higher incidence of reoperations (12% versus 6%), but the average of UPRBC used (4.31 versus 1.25) and mean length of hospital stay (10.8 versus 7.4 days) was lower. Univariate and multivariate analysis, were performed, which showed no statistically significant values, except in the use of UPRBC. The relationship between the CS and the cost of RBC was not cost / effective and length of stay was shorter.Conclusion: The use of CS decreases the number of used UPRBC, is not cost / effective but has shown benefits for patients.
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INTRODUCTIONSeveral methods have been used to decrease the use of homologous blood with the progress and increased knowledge of the pathophysiology of cardiopulmonary bypass. This has been a path, with the highest incidence of use in patients for religious reasons and those who do not wish to make use of units of stored packed red blood cells (UPRBC). The use of this strategy varies from services to services in different continents, between 15% and 60% [1].In recent years, efforts have been made to decrease more and more the use of homologous blood, with recovery of autologous blood during surgery and sometimes even in the postoperative period [2], along with a more hemostasis strict protocols throughout the surgical procedures. Cell savers machines (CS) have been used [3] in adult patients with high risk of bleeding, due to the fact that they decrease the inflammatory response to cardiopulmonary bypass. The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists [4], in its guidelines for 2007, considered as class I the use of CS. However, several authors have shown that the use of CS is not as beneficial as stated [5,6] and is not cost-effective [7][8][9].In order to clarify this issue, the authors devised this work, which aims to verify that the primary use of CS in cardiovascular surgery with cardiopulmonary bypass (CPB), is cost-effective. As a secondary objective, we sought to identify a reduction in the use of units of UPRBC in patien...
