Cell saver for on-pump coronary operations reduces systemic inflammatory markers: a randomized trial

Area of Science:

• Cardiovascular Surgery
• Immunology
• Anesthesiology

Background:

• Investigating the systemic inflammatory response following cardiopulmonary bypass (CPB) is crucial for improving patient outcomes.
• Intraoperative blood management strategies may influence postoperative inflammatory markers.

Purpose of the Study:

• To determine if intraoperative cell saver use mitigates the systemic inflammatory response after coronary operations involving CPB.
• To assess the impact of cell saving on specific plasma inflammatory markers.

Main Methods:

• A randomized controlled trial involving 29 patients undergoing coronary operations with CPB.
• Patients were assigned to either a cell saver group (reprocessing pericardial and CPB circuit blood) or a control group (direct retransfusion).
• Plasma levels of various inflammatory markers (IL-1beta, IL-6, IL-8, IL-10, IL-12, TNF-alpha, sTNFRs, procalcitonin) were measured at 6, 24, and 72 hours postoperatively.

Main Results:

• The cell saver group showed significantly lower plasma IL-6 and IL-8 levels at 6 hours postoperatively (p < 0.05).
• A trend towards reduced IL-10 was observed (p = 0.05), with non-significant reductions in other markers.
• The cell saver effectively cleared tumor necrosis factor receptors and reduced IL-6, IL-8, IL-10, and procalcitonin in the processed blood.
• Lower intraoperative blood loss and higher immediate postoperative hemoglobin were noted in the cell saver group, with similar transfusion needs.

Conclusions:

• Intraoperative cell saver use effectively reduces systemic levels of proinflammatory markers IL-6 and IL-8 at 6 hours after CPB.
• The specific roles of anti-inflammatory molecules like IL-10 and soluble tumor necrosis factor receptors in this context require further investigation.