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Autotransfusion decreases blood usage following cardiac surgery -- a prospective randomized trial
M J Dalrymple-Hay1, S Dawkins, L Pack
1Wessex Cardiothoracic Centre, Southampton, UK. mdh@btinternet.com
Insights
Autotransfusion of washed mediastinal fluid effectively reduces homologous blood transfusions in cardiac surgery patients. Processing cardiopulmonary bypass (CPB) blood alongside drainage fluid offered no additional benefit.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Cardiac procedures utilize 10% of blood supply, necessitating reduced transfusion rates due to risks and costs.
- Autotransfusion strategies are explored to mitigate homologous blood use in cardiac surgery.
- Washed postoperative mediastinal fluid presents a potential autotransfusion source.
Purpose of the Study:
- To evaluate the efficacy of autotransfusion using washed postoperative mediastinal fluid.
- To compare autotransfusion methods in patients undergoing coronary artery bypass grafting (CABG) and valve procedures.
- To determine if processing cardiopulmonary bypass (CPB) circuit blood offers additional benefits.
Main Methods:
- A prospective randomized trial involving 166 patients undergoing cardiac surgery (CABG, valve, or combined).
- Patients were randomized into three groups: mediastinal fluid autotransfusion, CPB blood and mediastinal fluid autotransfusion, and control.
- Transfusion criteria included postoperative hemoglobin < 10 g/l or packed cell volume < 30%.
Main Results:
- No significant differences in patient demographics or preoperative hematological parameters across groups.
- Autotransfusion of washed mediastinal fluid (Group A) and CPB blood with mediastinal fluid (Group B) reduced homologous blood requirements.
- Twelve patients in Group A and 10 in Group B avoided homologous transfusion.
Conclusions:
- Autotransfusion of washed postoperative mediastinal fluid is effective in decreasing homologous blood transfusions after cardiac surgery.
- Processing CPB circuit blood in addition to mediastinal drainage fluid did not provide a demonstrable benefit.
- This approach offers a viable strategy to conserve blood resources in cardiac surgery.
Introduction:
10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial.
Patients And Methods:
166 patients undergoing coronary artery bypass grafting (CABG), valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance.
Results:
There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. [table - see text] Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid.
Conclusion:
Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.
