A quality assurance programme for cell salvage in cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Transfusion Medicine

Background:

• Cell salvage is a blood conservation technique used during cardiac surgery with cardiopulmonary bypass.
• Implementing a quality assurance program is crucial for ensuring the safety and efficacy of cell salvage.

Purpose of the Study:

• To evaluate the safety and efficacy of cell salvage in cardiac surgery through a quality assurance program.
• To monitor key parameters including heparin, hemoglobin, and free hemoglobin concentrations.

Main Methods:

• A retrospective analysis of data from patients undergoing cardiac surgery between 2001 and 2007.
• Monitoring pre- and post-wash heparin, hemoglobin, and free hemoglobin concentrations in salvaged blood.
• Utilizing the quality assurance program to detect changes in operator behavior and equipment performance.

Main Results:

• Cell salvage was used in 94% of the 7243 patients.
• Post-wash heparin concentration remained consistently low (< 0.4 IU/ml).
• A significant decrease in post-wash hemoglobin was observed in 2003, and a significant increase in free plasma hemoglobin in 2006, prompting interventions.

Conclusions:

• The quality assurance program effectively identified critical changes in cell salvage practice, including operator behavior and machine deterioration.
• This proactive monitoring allowed for timely interventions, such as fleet replacement, ensuring continued patient safety and optimal outcomes.
• Continuous quality improvement is essential for maintaining the effectiveness of cell salvage in cardiac surgery.