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A comparison of intra-operative cell-saving strategies upon immediate post-operative outcomes after CPB-assisted
Je Marcoux1, M Rosin, E McNair
1Royal University Hospital, Saskatoon, Saskatchewan.
Insights
Using a cell saver during cardiac surgery with cardiopulmonary bypass can improve post-operative hemoglobin levels and reduce ICU time without increasing transfusion rates or drainage compared to traditional cardiotomy suction.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Cardiotomy suction during cardiopulmonary bypass (CPB) is linked to adverse patient outcomes.
- Potential detrimental effects of cardiotomy suction include blood loss and inflammatory responses.
- Alternative methods to manage shed blood during CPB are sought to improve patient safety.
Purpose of the Study:
- To evaluate the impact of routine intra-operative cell saver (CS) use versus no cell saver (NCS) during cardiac surgery.
- To determine if CS use affects transfusion rate (TR), chest tube drainage (CTD), ventilation time (VT), or intensive care unit length of stay (ICULOS).
- To assess if CS can mitigate adverse outcomes associated with cardiotomy suction.
Main Methods:
- Retrospective analysis of 69 patients in the NCS group.
- Prospective data collection from 219 patients in the CS group.
- Comparison of TR, CTD, VT, ICULOS, and post-operative hemoglobin between the two groups.
Main Results:
- No significant difference in transfusion rate, chest tube drainage, or ventilation time between NCS and CS groups.
- Significantly higher post-operative hemoglobin concentrations observed in the CS group (p<0.0001).
- Significantly shorter intensive care unit length of stay (ICULOS) in the CS group (p=0.018).
Conclusions:
- Routine intra-operative cell saver use in cardiac surgery with CPB is safe and does not negatively impact key perioperative outcomes.
- Cell saver utilization is associated with improved post-operative hemoglobin levels and reduced ICU length of stay.
- Cell saver offers a viable alternative to cardiotomy suction, potentially improving patient recovery and resource utilization.
Abstract:
Cardiotomy suction has been associated with adverse outcomes under routine conditions in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). We hypothesized that the routine use of a cell saver (CS) in place of the cardiotomy sucker would have no negative impact on transfusion rate (TR), chest tube drainage (CTD), ventilation time (VT) or intensive care unit length of stay (ICULOS) while avoiding the detrimental effects of cardiotomy suction. Retrospective data were collected from 69 patients where a cell saver was not used (NCS). Prospective data were collected from 219 patients who were followed after the implementation of an intra-operative cell saver. No significant increase in transfusion rate, chest tube drainage or ventilation time was found between the NCS group and the CS group. However, post-operative hemoglobin concentrations were significantly higher in the CS group (0.0001) and the CS group spent significantly less time in the ICU (p=0.018).
