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Cell-based Therapy for Heart Failure in Rat: Double Thoracotomy for Myocardial Infarction and Epicardial Implantation of Cells and Biomatrix
Published on: September 22, 2014
A randomized controlled trial of cell salvage in routine cardiac surgery
Andrew A Klein1, Samer A M Nashef, Linda Sharples
1Department of Anaesthesia, Papworth Hospital, Cambridge, CB23 3RE, UK. andrew.klein@papworth.nhs.uk
Insights
Routine cell salvage in cardiac surgery did not reduce allogeneic blood transfusion rates but decreased units transfused in patients without re-exploration for bleeding, at increased cost.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Economics
Background:
- Previous studies suggest cell salvage reduces transfusions in cardiac surgery but had limitations.
- Rigorous transfusion protocols and antifibrinolytic use were inconsistently applied in prior trials.
- This study evaluated cell salvage efficacy and cost-effectiveness in a controlled setting.
Purpose of the Study:
- To determine if routine cell salvage reduces allogeneic blood transfusion in elective cardiac surgery.
- To assess the cost-effectiveness of cell salvage under a strict transfusion protocol.
- To evaluate cell salvage in the context of antifibrinolytic therapy.
Main Methods:
- A randomized controlled trial involving 213 patients undergoing first-time coronary artery bypass grafting and/or valve surgery.
- Patients were randomized to either a control group or a cell salvage group.
- The cell salvage group received autotransfused blood processed from surgical aspirates and mediastinal drainage; all patients received tranexamic acid and followed a transfusion algorithm.
Main Results:
- No significant difference in the proportion of patients receiving allogeneic blood (32% in both groups).
- Cell salvage increased costs by at least $103 per patient.
- Excluding patients with mediastinal re-exploration, the cell salvage group received significantly fewer units of red blood cells (65 vs. 100 units).
Conclusions:
- Routine cell salvage does not reduce the proportion of patients needing allogeneic transfusions in cardiac surgery within a robust blood conservation program.
- Cell salvage did reduce the number of red blood cell units transfused in patients without excessive bleeding.
- While potentially reducing blood product demand, cell salvage increases institutional costs.
Background:
Previous trials have indicated that cell salvage may reduce allogeneic blood transfusion during cardiac surgery, but these studies have limitations, including inconsistent use of other blood transfusion-sparing strategies. We designed a randomized controlled trial to determine whether routine cell salvage for elective uncomplicated cardiac surgery reduces blood transfusion and is cost effective in the setting of a rigorous transfusion protocol and routine administration of antifibrinolytics.
Methods:
Two-hundred-thirteen patients presenting for first-time coronary artery bypass grafting and/or cardiac valve surgery were prospectively randomized to control or cell salvage groups. The latter group had blood aspirate during surgery and mediastinal drainage the first 6 h after surgery processed in a cell saver device and autotransfused. All patients received tranexamic acid and were subjected to an algorithm for red blood cell and hemostatic blood factor transfusion.
Results:
There was no difference between the two groups in the proportion of patients exposed to allogeneic blood (32% in both groups, relative risk 1.0 P = 0.89). At current blood products and cell saver prices, the use of cell salvage increased the costs per patient by a minimum of $103. When patients who had mediastinal re-exploration for bleeding were excluded (as planned in the protocol), significantly fewer units of allogeneic red blood cells were transfused in the cell salvage compared with the control group (65 vs 100 U, relative risk 0.71 P = 0.04).
Conclusion:
In patients undergoing routine first-time cardiac surgery in an institution with a rigorous blood conservation program, the routine use of cell salvage does not further reduce the proportion of patients exposed to allogeneic blood transfusion. However, patients who do not have excessive bleeding after surgery receive significantly fewer units of blood with cell salvage. Although the use of cell savage may reduce the demand for blood products during cardiac surgery, this comes at an increased cost to the institution.
