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Blood product use during routine open heart surgery: the impact of the centrifugal pump
M Klein1, C B Mahoney, C Probst
1Department of Cardiothoracic Surgery, Heinrich-Heine University Hospital, Düsseldorf, Germany.
Insights
This study found that using a centrifugal pump during open heart surgery significantly reduced chest tube drainage and blood transfusions, leading to shorter hospital stays for patients. This contrasts with roller pumps, showing improved patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Open heart surgery necessitates extracorporeal circulation, often involving blood product transfusions and potential complications like excessive chest tube drainage.
- Optimizing extracorporeal circuits is crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To compare the clinical outcomes of using a roller pump versus a centrifugal pump in patients undergoing routine open heart surgery.
- To identify predictors of blood product transfusion requirements and chest tube drainage (CTD).
Main Methods:
- A prospective randomized study involving 1,000 patients undergoing open heart surgery.
- Patients were assigned to either a roller pump or a BioMedicus centrifugal pump with identical extracorporeal circuits.
- Transfusion data, predicted transfusion needs (Cardiac RiskMaster), and CTD were analyzed.
Main Results:
- The centrifugal pump was the only significant predictor of decreased chest tube drainage.
- Emergency surgery, increased cross-clamp time, and higher predicted mortality risk predicted increased CTD and blood product use.
- Myocardial infarction, preoperative urea, age, and massive transfusion predicted longer hospital stays.
Conclusions:
- The use of a centrifugal pump in extracorporeal circuits significantly improves patient outcomes.
- Centrifugal pumps decrease chest tube drainage and reduce the need for blood transfusions, contributing to shorter hospital stays.
Abstract:
A prospective randomized study was done including 1,000 patients undergoing routine open heart surgery. Patients were randomly assigned to either a roller pump or a BioMedicus centrifugal pump with identical extracorporeal circuits. There were no significant differences between study groups. Actual blood products transfused and predicted transfusion requirements (using Cardiac RiskMaster) were examined as was chest tube drainage (CTD). The predicted transfusion requirement was 885 of 1,000 patients. Transfusions were required by 472 of 1,000. Risk factors as significant predictors of increased CTD and use of blood products were emergency surgery status, increased cross-clamp time, and higher predicted risk of mortality. The only significant predictor of decreased CTD was the use of a centrifugal pump. Predictors of increased length of stay were myocardial infarction, preoperative urea, age, and massive transfusion. Data provide evidence that use of the centrifugal pump improves patient outcomes by decreasing CTD and decreasing the requirements for transfusion, which results in a shorter hospital stay.
