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The use of cell saver system in cardiac surgery with cardiopulmonary bypass
Rui M S Almeida1, Luciano Leitão
1Institute of Cardiovascular Surgery of Paraná, Cascavel, Paraná, Brazil. ruimsalmeida@iccop.com.br
Insights
Cell saver (CS) use in cardiac surgery reduces stored packed red blood cell units. While not cost-effective, CS demonstrates patient benefits by lowering blood product usage.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Patient Outcomes
Background:
- Cell saver (CS) is proposed to minimize allogeneic blood transfusions in cardiac surgery.
- Allogeneic blood transfusions are associated with increased morbidity, mortality, and inflammatory responses.
Purpose of the Study:
- To evaluate the efficacy of CS in reducing the use of stored packed red blood cells (URBC).
- To assess the cost-effectiveness and patient benefits of CS during cardiovascular surgery.
Main Methods:
- A prospective study enrolled 100 patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB).
- Patients were divided into two groups: no CS (Group 1) and CS (Group 2).
- Red blood cell (RBC) replacement criteria included hemodynamic instability and hemoglobin <7-8 g/dL.
Main Results:
- Group 2 (CS) showed a significant reduction in URBC usage (1.25 units) compared to Group 1 (4.31 units).
- The mean length of hospital stay was shorter in Group 2 (7.4 days) versus Group 1 (10.8 days).
- CS was not found to be cost-effective, and no statistically significant differences in mortality or other analyzed parameters were observed, except for URBC usage.
Conclusions:
- Cell saver (CS) effectively decreases the number of units of packed red blood cells used in cardiac surgery.
- Despite not being cost-effective, CS offers patient benefits, including a reduced length of hospital stay.
Introduction:
The use of cell saver (CS) in cardiac surgery is proposed to reduce the use of units of packed red blood cells stored (URBC), which increases morbidity, mortality and causes inflammatory reactions.
Objective:
The objective is to evaluate whether the use of CS decreases the use URBC, is cost /effective and beneficial to the patient.
Methods:
In a prospective study, between November 2009 and October 2011, 100 consecutive patients who underwent cardiovascular surgery with CPB, hemodilution and hemofiltration, were enrolled. Patients were divided into group 1 (no CS) and 2 (CS). The criteria for the replacement of RBC were hemodynamic instability and hemoglobin (Hb) <7-8g/dl. Demographic data, as well as Hb and hematocrit, mediastinal drainage, number of URBC and CPB, ICU and hospital time, were analysed.
Results:
In groups 1 and 2 the average age was 64.1 and 60.6 years; predominantly male; the logistic EuroSCORE 10.3 and 9.4; mortality 2% and 4%. Group 2 had a higher incidence of reoperations (12% versus 6%), but the average of URBC used (4.31 versus 1.25) and mean length of hospital stay (10.8 versus 7.4 days) was lower. Univariate and multivariate analysis, were performed, which showed no statistically significant values, except in the use of URBC. The relationship between the CS and the cost of RBC was not cost /effective and length of stay was shorter.
Conclusion:
The use of CS decreases the number of used URBC, is not cost /effective but has shown benefits for patients.
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