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Processing scavenged blood with a cell saver reduces cerebral lipid microembolization
E H Kincaid1, T J Jones, D A Stump
1Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Insights
Using a cell saver to process shed blood during cardiopulmonary bypass (CPB) significantly reduces cerebral lipid microemboli. This method is more effective than arterial filters in preventing microembolization and potential brain injury.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Biomedical Engineering
Background:
- Cardiopulmonary bypass (CPB) can lead to cerebral microembolization, characterized by lipid deposits causing small capillary and arteriolar dilations (SCADs), ischemic injury, and neuronal dysfunction.
- Increased SCAD density is associated with cardiotomy suction used to scavenge shed blood during CPB.
Purpose of the Study:
- To investigate whether different methods of processing shed blood during CPB can reduce the burden of cerebral lipid microemboli.
Main Methods:
- Mongrel dogs underwent hypothermic CPB (70 minutes).
- Brain tissue was analyzed for SCADs in two groups: arterial filter (AF) processing of shed blood and cell saver (CS) processing.
- The AF group used various arterial line filters, while the CS group used intermittent or continuous-action cell savers, with and without leukocyte filtration.
Main Results:
- The CS group exhibited significantly lower mean SCAD density (11 ± 3 SCADs/cm²) compared to the AF group (24 ± 5 SCADs/cm², p = 0.02).
- Leukocyte filtration and specific arterial line filters did not significantly alter SCAD density.
- Continuous-action cell savers showed a trend towards lower SCAD density (8 ± 2 SCADs/cm²) than intermittent-action devices (13 ± 5 SCADs/cm²).
Conclusions:
- Processing shed blood with a cell saver during CPB effectively decreases cerebral lipid microembolization.
- Cell saver technology offers a superior approach to managing shed blood compared to traditional arterial filters in mitigating CPB-induced brain microemboli.
Background:
Microembolization during cardiopulmonary bypass (CPB) can be detected in the brain as lipid deposits that create small capillary and arteriolar dilations (SCADs) with ischemic injury and neuronal dysfunction. SCAD density is increased with the use of cardiotomy suction to scavenge shed blood. Our purpose was to determine whether various methods of processing shed blood during CPB decrease cerebral lipid microembolic burden.
Methods:
After hypothermic CPB (70 minutes), brain tissue from two groups of mongrel dogs (28 to 35 kg) was examined for the presence of SCADs. In the arterial filter (AF) group (n = 12), shed blood was collected in a cardiotomy suction reservoir and reinfused through the arterial circuit. Three different arterial line filters (Pall LeukoGuard, Pall StatPrime, Bentley Duraflo) were used alone and in various combinations. In the cell saver (CS) group (n = 12), shed blood was collected in a cell saver with intermittent preocessing (Medtronic autoLog model) or a continuous-action cell saver (Fresenius Continuous Auto Transfusion System) and reinfused with and without leukocyte filtration through the CPB circuit.
Results:
Mean SCAD density (SCAD/cm2) in the CS group was less than the AF group (11 +/- 3 vs 24 +/- 5, p = 0.02). There were no significant differences in SCAD density with leukocyte filtration or with the various arterial line filters. Mean SCAD density for the continuous-action cell saver was 8 +/- 2 versus 13 +/- 5 for the intermittent-action device.
Conclusions:
Use of a cell saver to scavenge shed blood during CPB decreases cerebral lipid microembolization.
