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Reduced transfusion requirements with a closed cardiopulmonary bypass system
S Casalino1, E Stelian, E Novelli
1Department of Anesthesia, San Gaudenzio Clinic, Novara, Italy. casalino63@libero.it
Insights
Using a closed cardiopulmonary bypass circuit significantly reduces blood transfusions in cardiac surgery patients at risk. This approach minimizes the need for transfused blood products while maintaining similar clinical outcomes.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Biomedical Engineering
Background:
- Cardiac surgery patients with predictive preoperative conditions often require blood transfusions.
- Minimizing allogeneic blood transfusions is a key goal in cardiac surgery to improve patient outcomes and reduce risks.
Purpose of the Study:
- To evaluate the efficacy of a closed cardiopulmonary bypass (CPB) circuit in reducing blood transfusion requirements in high-risk cardiac surgery patients.
- To compare transfusion volumes between open and closed CPB circuit systems.
Main Methods:
- A randomized study involving 60 cardiac surgery patients assigned to either an open (N=30) or closed (N=30) CPB circuit.
- Both circuits included a membrane oxygenator and arterial line filter; the closed circuit additionally featured a collapsible venous reservoir.
- Transfused packed red blood cells were measured until hospital discharge.
Main Results:
- The closed CPB circuit group had a significantly lower priming volume (760 mL vs. 1180 mL).
- Patients in the closed circuit group received significantly less packed red blood cells (378 mL) compared to the open circuit group (717 mL).
- No significant differences in clinical outcomes were observed between the two groups.
Conclusions:
- The use of a closed cardiopulmonary bypass circuit effectively reduces the volume of transfused blood products in cardiac surgery patients.
- This strategy is particularly beneficial for patients with preoperative conditions indicating a high likelihood of transfusion needs.
Aim:
The aim of this investigation is to reduce blood transfusion in cardiac surgery patients with preoperative conditions predictive for transfusion requirements. We compared the amount of blood transfused in two groups of patients undergoing cardiopulmonary bypass (CPB) with two different circuit systems.
Methods:
Sixty patients undergoing cardiac surgery were randomly assigned to two groups: in group A (N=30) cardiopulmonary bypass was accomplished with an open circuit and in group B (N=30) with a closed circuit. The open circuit consisted of a cardiotomy reservoir, a membrane oxygenator and an arterial line filter, while the closed circuit was made up of a collapsible venous reservoir, a membrane oxygenator, an arterial line filter and a cardiotomy reservoir. The amount of transfused packed red cells in each patient was measured until discharge from the hospital.
Results:
Groups were similar regarding age, gender, body surface area (BSA), New York Heart Association (NYHA) class and comorbidity risk factors. Moreover, there were no significant differences between groups regarding the type of procedures, CPB and aortic cross-clamp times, total amount of cardioplegia and urinary output during CPB. Priming volume was 1180+/-84 mL (group A) and 760+/-72 mL (group B) (P<0.001). Significant differences in transfusion requirements emerged in the two groups: the total volume of packed red cells transfused for each patient was significantly higher in the open system group compared to the closed system group (717+/-486 mL versus 378+/-364 mL) (P=0.003). Clinical outcomes were similar in both groups.
Conclusion:
In patients with preoperative conditions predictive for the need of transfusions, the use of a closed cardiopulmonary bypass circuit can diminish the amount of transfused blood products.
