Effects of Cell-Saving Devices and Filters on Transfusion in Cardiac Surgery: A Multicenter Randomized Study

Vermeijden, Wytze J.; Klarenbosch, Jan van; Gu, Yongquan; Mariani, Massimo A.; Buhre, W.; Scheeren, Thomas; Hagenaars, Johanna A. M.; Tan, Mengwei; Haenen, Jo; Bras, Leo; Oeveren, Wim van; Heuvel, Edwin R. van den; Vries, Adrianus J. de

doi:10.1016/j.athoracsur.2014.08.027

Cited by 24 publications

(33 citation statements)

References 21 publications

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“…The decreased risk of perioperative pRBC transfusions found in patients who received ICS in our study compared favourably to findings from certain previously published studies 8,12,[14][15][16]19,22 but differed from others where either no change 7,9,13,18 or an increase in perioperative pRBC transfusion rates 17 was noted with the use of ICS. With respect to coagulation product transfusion, to our knowledge, the present study is the first to have shown a decrease in coagulation product transfusion with the use of ICS.…”

Section: Discussionsupporting

confidence: 75%

“…Few ICS studies explicitly stated whether or not residual CPB contents were processed through the cell saver. Of those that did, it appears that the processing of residual CPB contents was associated with a significant decrease in pRBC transfusion 12,14,15,19,22 and a decrease in postoperative chest tube drainage. 19 The beneficial effect of ICS seen when processing residual CPB contents may result, in part, from the removal of excess heparin 23 or an accumulation of inflammatory mediators commonly associated with CPB.…”

Section: Icsmentioning

confidence: 99%

“…Despite these theoretical benefits, evidence as to whether ICS is safe and effective has been conflicting. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Several studies have shown ICS to reduce exposure to allogeneic blood products with no changes in clinical outcomes or cost, [14][15][16][19][20][21][22] while others have suggested that reinfusion with washed cell salvaged blood results in increased postoperative bleeding and heightened transfusion. 17 The purpose of this study was to determine the effect of ICS on outcomes following cardiac surgery.…”

mentioning

confidence: 99%

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Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study

et al. 2016

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Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study Background: Evidence regarding the safety and efficacy of intraoperative cell salvage (ICS) in transfusion reduction during cardiac surgery remains conflicting. We sought to evaluate the impact of routine ICS on outcomes following cardiac surgery. Methods: We conducted a retrospective analysis of patients who underwent non emergent, first-time cardiac surgery 18 months before and 18 months after the implementation of routine ICS. Perioperative transfusion rates, postoperative bleeding, clinical and hematological outcomes, and overall cost were examined. We used multivariable logistic regression modelling to determine the risk-adjusted effect of ICS on likelihood of perioperative transfusion. Contexte : Les résultats d'études portant sur l'innocuité et l'efficacité de l'autotransfusion peropératoire (ATPO) comme mesure de réduction du besoin de transfusion durant une chirurgie cardiaque sont contradictoires. Nous avons cherché à évaluer l'incidence du recours systématique à l'ATPO sur les issues de chirurgies cardiaques. Méthodes : Nous avons mené une analyse rétrospective portant sur des patients ayant subi une première chirurgie cardiaque non urgente 18 mois avant et 18 mois après l'introduction de l'ATPO systématique. Les taux de transfusion périopératoire et d'hémorragie postopératoire, les résultats cliniques et hématologiques et le coût total ont été analysés. Nous avons utilisé un modèle de régression logistique multivariée pour déterminer l'incidence ajustée en fonction du risque du recours à l'ATPO sur la probabilité qu'une transfusion périopératoire soit nécessaire. Résultats : L'échantillon à l'étude était composé de 389 patients (186 dans le groupe ATPO et 203 dans le groupe témoin). Par rapport au groupe témoin, les patients ayant reçu une ATPO ont eu besoin significativement moins souvent d'une transfusion de concentrés de globules rouges (33,9 % c. 45,3 %; p = 0,021), de produits coagulants (16,7 % c. 32,5 %; p < 0,001) et de produits sanguins, tous types confondus (38,2 % c. 52,7 %; p = 0,004). Chez les patients ayant reçu une ATPO, on a constaté un volume de drainage médiastinal après 12 h plus faible (moyenne : 320 mL [étendue de 230-550]

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Section: Discussionsupporting

confidence: 75%

Section: Icsmentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study

et al. 2016

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“…Using the new definition, incidence of AMB is rather low but close to the rate reported other study which used similar criteria (3.7%) (2). Identifying bleeding patients with these timely but binding criteria may allow an aggressive therapeutic strategy that may help to reduce BV and transfusion.…”

supporting

confidence: 69%

Acute massive bleeding after cardiac surgery: a new definition evaluated in a multicenter study

Colson¹,

Gaudard²,

Fellahi³

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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“…These patients were part of our randomized factorial multicenter trial (ISRCTN 58333401) on cell salvage and filter use. The primary endpoint for that trial was the number of allogeneic blood products transfused in each group during hospital admission, and its main conclusion was that cell salvage, with or without a filter, does not significantly reduce the total number of allogeneic blood products, but reduces the percentage of patients who need blood products during cardiac surgery …”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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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.

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Effects of Cell-Saving Devices and Filters on Transfusion in Cardiac Surgery: A Multicenter Randomized Study

Cited by 24 publications

References 21 publications

Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study

Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study

Acute massive bleeding after cardiac surgery: a new definition evaluated in a multicenter study

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

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