Transfusion of Cell Saver Salvaged Blood in Neonates and Infants Undergoing Open Heart Surgery Significantly Reduces RBC and Coagulant Product Transfusions and Donor Exposures

Abstract

Objective To evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hours, would decrease the number of post-operative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes. Design Prospective, randomized, controlled, clinical trial. Setting Pediatric cardiac intensive care unit. Patients Infants <20kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass. Interventions Subjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hours post-collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups. Measurements and Main Results Children randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 v. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hours post-op (cell saver: 0.09 ± 0.45 v. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 v. control: 2.3 ± 4.8; p =0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 v. control: 1.1 ± 1.4; p =0.07). There were no significant clinical outcome differences. Conclusion Cell saver blood can be safely stored at the bedside for immediate transfusion for 24 hours post-collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate post-operative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease post-operative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.

Processing of small volumes in blood salvage devices

“…The application of IBS is able to reduce perioperative RBC transfusions in small children . However, the minimal blood volume for effective processing has not yet been determined.…”

“…Only recent developments in cell saver equipment provided the technical requirements for the processing of small volumes, like a small‐volume Latham bowl with a smaller capacity, a continuously operating cell separation system, and a device for processing postoperative drainage blood . There is substantial evidence that IBS considerably reduces perioperative RBC transfusions in infants and small children . Furthermore, the use of cell salvage appeared cost‐saving and cost‐effective in pediatric surgery .…”

Blood Transfusions After Pediatric Cardiac Operations: A North American Multicenter Prospective Study

“…Several strategies have been successfully used to reduce the need for postoperative RBC transfusion. These include the use of miniaturized cardiopulmonary bypass circuits [28,29], cardiopulmonary bypass circuit residual blood reinfusion [30,31], and use of pharmacologic agents, such as recombinant activated factor VIIa, to reduce intraoperative bleeding [32]. The efficacy and the safety of some of these measures remains to be better evaluated, but the principle of blood preservation during cardiac operations should always remain in the mind of practitioners.…”

Cardiac critical care

“…Restrictive transfusion strategies during cardiopulmonary bypass (CPB) for congenital heart surgery have been investigated by Newburger et al [55] in a prospective randomized trial targeting a hematocrit of 25 versus 35% during hypothermic CPB in infant heart surgery. Furthermore, there were also no differences among groups with respect to infection, duration of mechanical ventilation, and overall hospital mortality, suggesting that a cell-saver salvage technique may provide a safe and effective means of RBC administration following cardiac surgery in children [57]. Additionally, no differences were demonstrated with respect to the Psychomotor and Mental Development Indexes of the Bayley Scales.…”