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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.
The Annals of Thoracic Surgery
|November 18, 2000
Summary
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.