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Effects of cell-saving devices and filters on transfusion in cardiac surgery: a multicenter randomized study
Wytze J Vermeijden1, Jan van Klarenbosch2, Y John Gu3
1Department of Intensive Care and Thorax Centre Twente, Medisch Spectrum Twente Enschede, Enschede, the Netherlands.
Insights
Cell-saving devices (CS) do not reduce overall blood product transfusions in cardiac surgery. However, CS use significantly decreases the percentage of patients requiring any blood products, highlighting its role in reducing transfusion incidence.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Cell-saving (CS) devices are widely used in cardiac surgery to minimize allogeneic blood transfusions.
- Evidence from randomized clinical trials supporting the efficacy of CS and filtration is limited.
- The routine use of filters with CS devices lacks robust data for justification.
Purpose of the Study:
- To evaluate the independent and combined effects of cell-saving devices and blood filtration on transfusion requirements in cardiac surgery.
- To determine the impact of CS and filters on the total number of allogeneic blood products transfused.
- To assess the influence of CS and filters on the proportion of patients receiving transfusions.
Main Methods:
- A multicenter factorial randomized clinical trial was conducted across academic and nonacademic hospitals.
- Patients undergoing elective coronary, valve, or combined surgical procedures were enrolled.
- The primary endpoint was the total number of allogeneic blood products transfused per patient during hospital admission.
Main Results:
- Neither cell-saving devices nor filters significantly reduced the total number of blood products transfused.
- Cell-saving devices significantly reduced red blood cell transfusions within 24 hours but not during the entire hospital stay.
- Cell-saving devices were associated with increased fresh frozen plasma transfusions and reduced the percentage of patients receiving any transfusion, while filters showed no significant effect on transfusion incidence.
Conclusions:
- Cell-saving devices, with or without filtration, do not decrease the overall volume of allogeneic blood products used in cardiac surgery.
- The use of cell-saving devices significantly reduces the percentage of patients requiring blood product transfusions.
- The routine addition of filters to cell-saving devices in cardiac surgery is not supported by this study's findings regarding overall transfusion reduction.
Background:
Cell-saving devices (CS) are frequently used in cardiac surgery to reduce transfusion requirements, but convincing evidence from randomized clinical trials is missing. Filtration of salvaged blood in combination with the CS is widely used to improve the quality of retransfused blood, but there are no data to justify this approach.
Methods:
To determine the contribution of CS and filters on transfusion requirements, we performed a multicenter factorial randomized clinical trial in two academic and four nonacademic hospitals. Patients undergoing elective coronary, valve, or combined surgical procedures were included. The primary end point was the number of allogeneic blood products transfused in each group during hospital admission.
Results:
From 738 included patients, 716 patients completed the study (CS+filter, 175; CS, 189; filter, 175; neither CS nor filter, 177). There was no significant effect of CS or filter on the total number of blood products (fraction [95% confidence interval]: CS, 0.96 [0.79, 1.18]; filter, 1.17 [0.96, 1.43]). Use of a CS significantly reduced red blood cell transfusions within 24 hours (0.75 [0.61,0.92]), but not during hospital stay (0.86 [0.71, 1.05]). Use of a CS was significantly associated with increased transfusions of fresh frozen plasma (1.39 [1.04, 1.86]), but not with platelets (1.25 [0.93, 1.68]). Use of a CS significantly reduced the percentage of patients who received any transfusion (odds ratio [95% confidence interval]: 0.67 [0.49, 0.91]), whereas filters did not (0.92 [0.68, 1.25]).
Conclusions:
Use of a CS, with or without a filter, does not reduce the total number of allogeneic blood products, but reduces the percentage of patients who need blood products during cardiac surgery.
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