Does use of cell saver decrease the inflammatory response in cardiac surgery?

Prieto, Maria A.; Guash, Sara; Méndez, José; Muñoz, Cecilia; Planas, Antonio; Reyes, Guillermo

doi:10.1177/0218492312446838

Cited by 11 publications

(7 citation statements)

References 19 publications

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“…Intraoperation autologous blood transfusion is an effective method that is used in surgeries with an important blood loss. One study has proved the use of a cell saver may reduce proinflammatory cytokine concentrations in patients undergoing cardiac surgery [19].…”

Section: Discussionmentioning

confidence: 99%

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery

Wang

Zhang

et al. 2015

Transfusion and Apheresis Science

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Section: Discussionmentioning

confidence: 99%

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery

Wang

Zhang

et al. 2015

Transfusion and Apheresis Science

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“…Blood transfusions alter humoral and cellular immunity in the recipient, particularly in the setting of cardiac surgery with cardiopulmonary bypass (CPB) (1–6); a procedure which in children, routinely requires red blood cell (RBC) transfusion (7,8). Children receiving greater numbers of RBC transfusions have increased post-operative complications and mortality (9–14).…”

Section: Introductionmentioning

confidence: 99%

Longer RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery

Cholette

Pietropaoli

Henrichs

et al. 2015

Pediatric Critical Care Medicine

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Background Infants and children undergoing open heart surgery routinely require multiple red blood cell (RBC) transfusions. Children receiving greater numbers of RBC transfusions have increased post-operative complications and mortality. Longer RBC storage age is also associated with increased morbidity and mortality in critically ill children. Whether the association of increased transfusions and worse outcomes can be ameliorated by use of fresh RBCs in pediatric cardiac surgery for congenital heart disease is unknown. Methods 128 consecutively transfused children undergoing repair or palliation of congenital heart disease with cardiopulmonary bypass who were participating in a randomized trial of washed v. standard RBC transfusions were evaluated for an association of RBC storage age and clinical outcomes. To avoid confounding with dose of transfusions and timing of infection versus timing of transfusion, a subgroup analysis of patients only transfused 1–2 units on the day of surgery was performed. Results Mortality was low (4.9%) with no association between RBC storage duration and survival. The post-operative infection rate was significantly higher in children receiving the oldest blood (25–38 days) compared to those receiving the freshest RBCs (7–15 days); (34% v. 7%; p = 0.004). Subgroup analysis of subjects receiving only 1–2 RBC transfusions on the day of surgery (n=74) also demonstrates a greater incidence of infections in subjects receiving the oldest RBC units [0 of 33 (0%) with 7–15 day storage, 1 of 21 (5%) with 16–24 day storage and 4 of 20 (20%) with 25–38 day storage; (p=0.01)]. In multivariate analysis, RBC storage age and corticosteroid administration were the only predictors of post-operative infection. Washing the oldest RBCs (>27 days) was associated with a higher infection rate and increased morbidity compared with unwashed RBCs. Discussion Longer RBC storage duration was associated with increased postoperative nosocomial infections. This association may be secondary in part, to the large doses of stored RBCs transfused, from single donor units. Washing the oldest RBCs was associated with increased morbidity, possibly from increased destruction of older, more fragile erythrocytes incurred by washing procedures. Additional studies examining the effect of RBC storage age on post-operative infection rate in pediatric cardiac surgery are warranted.

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“…Prieto et al did not find a decrease of inflammatory response after CS investigating interleukin 1β, 6, 8, and 12, p40 subunit of interleukin 23 and interferon γ. 6 Bauer et al described an attenuating effect of CS during MECC on the course of TNFα but not for C-reactive protein and procalcitonin. 7 In our recent comparison out of several investigated inflammation markers TNFα, sICAM, and Pselectin showed some differences in time courses comparing ONCAB with MECC or OPAB.…”

Section: Discussionmentioning

confidence: 98%

Pericardial fluids or Cardiopulmonary Bypass—Is There a Major Culprit for Changes in Coagulation and Inflammation?

Gorki¹,

Nakamura²,

Kunert³

et al. 2019

Thorac cardiovasc Surg

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Background From the results of a previous study, it remained to be investigated if a perioperative rise of few tested coagulation and inflammation markers is caused by conventional cardiopulmonary bypass (CPB) itself or rather by direct recirculation of pericardial fluids. Methods Forty-eight patients operated on with conventional CPB for myocardial revascularization were randomized either for direct recirculation of pericardial suction fluids or for cell saving (CS). Results Thrombin–antithrombin complexes showed lower values intraoperatively in the CS group (p < 0.0001), and D-dimers tended to remain lower at intensive care unit arrival (p = 0.095). Tests of inflammation markers were less meaningful. Conclusion Direct recirculation of pericardial fluids rather than conventional CPB itself causes major intraoperative changes of some coagulation markers. Pericardial blood loss with direct recirculation should be kept to a minimum to avoid unnecessary activation of coagulation. Inflammation markers need further investigations.

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Does use of cell saver decrease the inflammatory response in cardiac surgery?

Abstract: Our results suggest that cell salvage in low-risk patients undergoing their first elective cardiac procedure does not decrease the inflammatory response after surgery.

Cited by 11 publications

References 19 publications

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery

Longer RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery

Pericardial fluids or Cardiopulmonary Bypass—Is There a Major Culprit for Changes in Coagulation and Inflammation?

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