Dealing with pericardial suction blood and residual pump volume: a review of current practices in the UK

Abstract

The pathological effects of pericardial suction blood (PSB) have been well described in numerous studies for many years; yet, despite this, there is no definitive answer to the question of how best to attenuate this pathology. More recently, large studies have shown that, whilst PSB contains many factors indicating its pathological potential, the direct re-infusion of PSB and residual pump volume (RPV) after cardiopulmonary bypass (CPB) potentially reduces the risk of transfusion and is no more harmful to the patient than the re-infusion of cell salvage-processed PSB after CPB.We conducted a telephone audit of UK perfusion units to determine if current protocols and practices reflected this.We found that there is a definite majority processing RPV with cell-saving devices, with many units defining their protocols as "surgeon dependent" whilst half immediately returned PSB to the systemic circulation whilst on CPB. The results of this national audit suggest that the issue of dealing with PSB and RPV is confused, heavily influenced by surgical and anaesthetic preference and lacking clear guidance and high quality evidence.

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

“…The infusion bag is retransfused either as it is or washed in a cellsaver 23 . It has been shown that when the blood is washed in a cellsaver the quality is improved 10,24,25 because heparin, inflammatory mediators and by-products from coagulation and fibrinolysis are removed.…”

“…The residual pump blood is retransfused after weaning from CPB 23 in order to reduce the need for allogenic blood transfusion. The most common technique is to retransfuse the blood by the IB technique, but the RC technique is also used.…”

“…It is common practice to retransfuse the residual blood after weaning from CPB 23 and it is considered to reduce the need for blood transfusion. There are different techniques to do this, where emptying the heart-lung machine and collect the blood in an infusion bag appears to be the most common (IB technique).…”

“…There are different techniques to do this, where emptying the heart-lung machine and collect the blood in an infusion bag appears to be the most common (IB technique). In Swedish cardio thoracic centers a large number of patients receive the residual pump blood by chasing it in with Ringers acetate through the heart-lung machine, the RCtechnique although the IB technique appears to be more common in other countries 23 .…”

“…Retransfusion of the residual pump blood is considered to be one method to reduce the need for allogenic blood transfusion 10,23 and to raise the hemoglobin levels 10,22 . Today there are three methods for transfusion available.…”