The inflammatory response to recycled pericardial suction blood and the influence of cell-saving

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Hematology

Background:

• Cardiotomy suction and cell-saver systems are used to manage shed blood during cardiac surgery.
• Understanding their impact on inflammatory and cellular responses is crucial for patient outcomes.

Purpose of the Study:

• To compare the inflammatory and cellular responses associated with conventional cardiotomy suction versus cell-saver technology during cardiac surgery.
• To evaluate the effects on proinflammatory cytokines, complement activation, leukocyte patterns, and hemolysis.

Main Methods:

• A randomized study involving 33 low-risk patients undergoing coronary artery bypass grafting.
• Patients were assigned to either cardiotomy suction or cell-saver groups for pericardial blood salvage.
• Comparison of inflammatory markers, complement activation, leukocyte counts, and hemolysis during and after cardiopulmonary bypass.

Main Results:

• Pericardial blood showed higher concentrations of free plasma hemoglobin, C3a, IL-6, IL-8, TNF-alpha, eosinophils, and basophils.
• No significant differences were observed in terminal complement complex or lymphocytes.
• Cell-saver effectively removed plasma hemoglobin, but did not alter other measured parameters.
• Recycling shed blood via cardiotomy suction increased free plasma hemoglobin systemically.

Conclusions:

• Cardiotomy suction is a primary contributor to hemolysis during cardiac surgery.
• Its contribution to the systemic inflammatory response is minimal.
• Cell-saver treatment of shed mediastinal blood effectively reduces hemolysis and potentially lowers the systemic load of inflammatory mediators.