Should the cardiotomy suction blood be cell-saver processed before retransfusion? A clinico-pathologic mystery

The use of cardiotomy suction (CS) in cardiopulmonary bypass (CPB) surgery is associated with a pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. However, CS is yet been employed to preserve autologous blood during on-pump surgery. Though processing CS blood with a cell saving device is considered paramount in significantly reducing the inflammatory effects, yet this might also have potential harmful effects on the outcome of the patient. Here we discuss the results of the different prospective and randomized studies to address these issue if the cell saver technique in processing CS blood before retransfusion is to establish its identity and role in the CPB surgery.