Processing scavenged blood with a cell saver reduces cerebral lipid microembolization

Kincaid, Edward H.; Jones, Timothy J.; Stump, David A.; Brown, William R.; Moody, Dixon M.; Deal, Dwight D.; Hammon, John W.

doi:10.1016/s0003-4975(00)01588-5

Cited by 130 publications

(95 citation statements)

References 19 publications

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“…7 Cell savers are commonly used in noncardiac surgery when excessive blood loss is a concern (eg, abdominal aortic aneurysm surgery). Cell savers clean and process shed blood, making it suitable for retransfusion into the patient.…”

Section: Editorial P 1879 Clinical Perspective P 1895mentioning

confidence: 99%

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Djaiani

Fedorko²,

Borger³

et al. 2007

Circulation

136

110

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Background-Cerebral microembolization during cardiopulmonary bypass may lead to cognitive decline after cardiac surgery. Transfusion of the unprocessed shed blood (major source of lipid microparticulates) into the patient during cardiopulmonary bypass is common practice to reduce blood loss and blood transfusion. Processing of shed blood with cell saver before transfusion may limit cerebral microembolization and reduce cognitive decline after surgery. Methods and Results-A total of 226 elderly patients were randomly allocated to either cell saver or control groups.Anesthesia and surgical management were standardized. Epiaortic scanning of the proximal thoracic aorta was performed in all patients. Transcranial Doppler was used to measure cerebral embolic rates. Standardized neuropsychological testing was conducted 1 week before and 6 weeks after surgery. The raw scores for each test were converted to Z scores, and then a combined Z score of 10 main variables was calculated for both study groups. The primary analysis was based on dichotomous composite cognitive outcome with a 1-SD rule. Cognitive dysfunction was present in 6% (95% confidence interval, 1.3% to 10.7%) of patients in the cell saver group and 15% (95% confidence interval, 8% to 22%) of patients in the control group 6 weeks after surgery (Pϭ0.038). The severity of aortic atheroma and cerebral embolic count were similar between the 2 groups. Conclusions-The present report demonstrates that processing of shed blood with cell saver results in clinically significant reduction in postoperative cognitive dysfunction after cardiac surgery. These findings emphasize the clinical importance of lipid embolization in contributing to postoperative cognitive decline in patients exposed to cardiopulmonary bypass.

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Section: Editorial P 1879 Clinical Perspective P 1895mentioning

confidence: 99%

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Djaiani

Fedorko²,

Borger³

et al. 2007

Circulation

136

110

View full text Add to dashboard Cite

show abstract

“…Clinical relevance is missing since numbers and pathogenicity of these bacteria are low and proliferation is minimized with immediate retransfusion of the blood. Therefore, microbiology testing in aseptic surgical procedures is not necessary [8]. The minimal requirements laid down for surgical procedures (working under sterile conditions, use of sterile disposables) also provide adequate hygienic conditions for IBS.…”

Section: Process Qualitymentioning

confidence: 99%

Proposal for Internal Quality Management in Intra- and Postoperative Blood Salvage

Hansen¹,

Altmeppen²

2002

Transfus Med Hemother

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A proposal of an expert group is reported that was put forward to facilitate the set-up of a system for quality management in intra- and postoperative blood salvage. Retransfusion of unwashed blood is excluded since it cannot meet quality criteria of modern transfusion medicine. Quality assurance is necessary to guarantee the high quality of autologous blood prepared during blood salvage with cell washing. It includes a profound understanding of the composition of shed blood and the preparation process, a thorough documentation, and the measurement of quality control parameters. Process quality can be assessed in regular samples by evaluation of red blood cell recovery (>80%) and plasma wash-out efficiency (>90%). Microbiology testing of this unstored blood is not recommended in sterile procedures for lack of consequence. Product quality should be monitored by volume and hematocrit (>50%) during every application.

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“…It has been demonstrated that blood suctioned via the standard cardiotomy suction system contains high levels of cellular debris and lipid microparticulates. 4 It also has been demonstrated that these lipid particles do embolize to the brain and are found in cerebral blood vessels. 5 The present study supports previous nonrandomized studies that suggest the important role of cell saver use in cardiac surgery to reduce neurological dysfunction after operation when CPB is used.…”

Section: Article P 1888mentioning

confidence: 99%

Neurocognitive Changes After Coronary Bypass Surgery

Baumgartner¹

2007

Circulation

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Processing scavenged blood with a cell saver reduces cerebral lipid microembolization

Cited by 130 publications

References 19 publications

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Continuous-Flow Cell Saver Reduces Cognitive Decline in Elderly Patients After Coronary Bypass Surgery

Proposal for Internal Quality Management in Intra- and Postoperative Blood Salvage

Neurocognitive Changes After Coronary Bypass Surgery

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