Are we doing everything we can to conserve blood during bypass? A national survey

Abstract

Despite growing concern about the potential detrimental effects of cardiotomy blood, few centers in Canada routinely manage this blood with additional filtration and/or centrifugal processing prior to reinfusion. Similarly, MUF, demonstrated to be effective in the pediatric population, has not seen popular application in adult cardiac surgical practice.

Trends in blood utilization in United States cardiac surgical patients

“…A meta‐analysis of 2282 cardiac surgery patients reported decreased use of allogeneic blood products (43.8% vs. 51.2%; OR, 0.63; 95% CI, 0.43‐0.94; p = 0.02) and RBCs (37.4% vs. 45.4%; OR, 0.60; 95% CI, 0.39‐0.92; p = 0.02) when cell salvage was used . However, underreporting of cell salvage in the NIS is a possibility, as a small survey of perfusionists in Canada showed a 40% use of centrifugal processing of cardiotomy blood . Of course, survey studies are subject to response bias, which may also influence data.…”

Ultrafiltration reduces blood transfusions following cardiac surgery: a meta-analysis

“…The benefits of UF, particularly MUF, are so pronounced in pediatric patients that MUF has been adopted as the standard of care in this population [14]. In adults, however, this technique is rarely used [15].…”

Pump blood processing, salvage and re-transfusion improves hemoglobin levels after coronary artery bypass grafting, but affects coagulative and fibrinolytic systems

“…Allogenic red blood cell (RBC) transfusions are associated not only with transmission of infections, but also with an increased mortality risk and adverse outcomes after cardiac surgery, including increased time to extubation, longer time in the intensive care unit (ICU) and postoperative length of stay, immunity alterations, acute lung injury, postoperative low cardiac output and long-term mortality 3-6 . Many strategies have been adopted to reduce transfusions in cardiac surgery; intra-operative cell salvage is one of these, applied by up to 40% of cardiac surgery teams 7 .…”