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

Abstract

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.

The effectiveness of cell salvage in extracorporeal circulation surgeries in relation to use of health resources after use: A systematic review and meta-analysis

“…Similarly, de Vries et al, in 2019, performed a comparison between Cell Salvage with and without filters. The results showed that the use of a filter did not increase the benefits of Cell Salvage in terms of reduced ICU days and hospitalization [ 29 ]. Along the same lines, Weltert et al in 2003 compared Cell Salvage with the cardioPAT system®.…”

“…In twelve RCTs, involving 2129 participants in both the intervention group (n = 1061) and the control group (n = 1068), the effectiveness of using the Cell Salvage was compared with the control group, where traditional methods based on allogeneic transfusion were employed. Five studies showed a high risk of bias [ 26 , 41 , 43 , 46 ], while one study demonstrated an adequate level of quality [ 29 , 33 , 34 , 36 , 47 ].…”

“…In eight RCTs, with a total sample size of 802 participants, considering the intervention group (n = 388) and the control group (n = 413), the effectiveness of using the Cell Salvage was compared with the control group in surgery time in minutes. Four studies showed a high risk of bias [ 39 , 43 , 45 , 49 ], other four demonstrated an adequate level of quality [ 28 , 29 , 34 , 50 ].…”

“…The role of the anti-inflammatory molecules IL-10 and soluble tumor necrosis factor receptors is undefined in this setting. De vries[ 29 ] (2019) (1-) The Netherlands Randomized clinical trial CS versus CS plus additional WBC depletion Filter CPB time: NA Cross-clamp time: p > 0.05 Operation time: NA Complications: p > 0.05 189 (71/118) 175 (80/95 To compare conventional CS with the HemoSep© device. CS: This CS (HemoSep©) device uses an approach that removes plasma and water from blood whilst retaining elements such as RBC or coagulation factors.…”