Blood salvage in cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Biomedical Engineering

Background:

• Cardiac surgery, particularly aortocoronary bypass, often necessitates homologous blood (HB) transfusions.
• Blood salvage techniques aim to reduce reliance on allogeneic blood products.
• Intraoperative and postoperative blood loss are significant concerns in cardiac procedures.

Purpose of the Study:

• To evaluate the efficacy of an intraoperative blood recovery system (IBRS) and a mediastinal drainage blood recovery system (MBRS) in reducing homologous blood transfusions during and after cardiac surgery.
• To compare the outcomes of using IBRS alone versus a combination of IBRS and MBRS against a control group receiving only HB.

Main Methods:

• A randomized controlled trial involving 66 patients undergoing aortocoronary bypass surgery.
• Three groups were established: Group I (HB only), Group II (IBRS), and Group III (IBRS + MBRS for 6 hours post-operation).
• Transfusion triggers included hematocrit <28% post-operation, <30% day after, and hemoglobin <10 g/dL on ward.

Main Results:

• Groups II and III showed significantly lower intraoperative HB transfusion requirements compared to Group I (P < 0.0001).
• Postoperative HB transfusions were also significantly lower in Group II and Group III versus Group I (P < 0.05).
• 13.6% of patients in Group II and 38% in Group III avoided HB transfusion entirely; no adverse events like infection or renal dysfunction were noted.

Conclusions:

• Intraoperative blood recovery systems (IBRS) effectively reduce homologous blood (HB) requirements in cardiac surgery.
• Combining IBRS with mediastinal drainage blood recovery systems (MBRS) offers superior blood conservation.
• Associated techniques like MBRS or predonation should be considered alongside IBRS to further minimize or eliminate HB transfusions.