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Can regional cerebral oxygen saturation guide red blood cell transfusion in high risk cardiac surgery?
P Carmona García1, E Mateo2, I Zarragoikoetxea1
1Departamento de Anestesiología y Reanimación, Hospital General Universitario La Fe, Valencia, España.
Insights
Red blood cell (RBC) transfusions did not significantly increase cerebral oxygen saturation (SrO2) in high-risk cardiac surgery patients. This suggests SrO2 may not be a reliable trigger for RBC transfusions in this population.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Cardiac surgery (CS) is associated with substantial blood product utilization.
- High-risk patients undergoing CS often require transfusions, necessitating evaluation of their impact on organ perfusion.
- Regional cerebral oxygen saturation (SrO2) is a monitored parameter during CS.
Purpose of the Study:
- To assess the effect of red blood cell concentrate (RBC) transfusion on regional cerebral oxygen saturation (SrO2).
- To evaluate SrO2 response in patients undergoing CS with elevated predicted risk (additive EuroSCORE I > 6).
Main Methods:
- Prospective descriptive study including 57 high-risk CS patients with extracorporeal circulation.
- Monitored SrO2, hemoglobin (HB), and recorded perioperative data, including complications and length of stay (LOS).
- Defined responders as those with a significant post-transfusion SrO2 increase; analyzed SrO2 changes after RBC transfusion.
Main Results:
- 35.1% of patients received intraoperative RBC transfusion.
- A significant decrease in SrO2 (>20% of baseline or <50%) occurred in 29.8% of patients, associated with higher complications and longer LOS.
- RBC transfusion led to a non-significant increase in SrO2 (59 to 61.1, P=0.1), with few responders identified.
Conclusions:
- The increase in SrO2 following RBC transfusion was not statistically significant in this cohort.
- Few patients met the criteria for SrO2 response post-transfusion.
- SrO2 may not serve as a reliable indicator for guiding RBC transfusion decisions in high-risk CS patients.
Introduction:
Cardiac surgery (CS) is associated with a significant use of blood products. The aim of this study was to evaluate the effect of red blood cells concentrates (RBC) transfusion on regional cerebral oxygen saturation (SrO2) in patients undergoing CS with additive EuroSCORE I > 6.
Material And Methods:
This is a prospective descriptive study. Patients with additive EuroSCORE I > 6 undergoing CS with extracorporeal circulation were included in the study. The demographic values, perioperative complications, hospital/ICU length of stay (LOS), as well as the preinduction baseline SrO2values, the lowest SrO2 value during surgery, number of blood products transfused, hemoglobine (HB) and pre and postransfusional SrO2 values were recorded, and events of significant decrease in SrO2 below 20% of basal value or decrease below 50%. We considered responders those who had an increase post-transfusion SrO2 at least 20% of pre-transfusion value, an increase of standar deviation (7.9) or an increase up to basal SrO2.
Results:
Data from 57 patients were collected. The average additive EuroSCORE I was 7.4 (SD 2.6) and the EuroSCORE II was 6.1 (SD 7.4). 52% were male. 35.1% of patients received intraoperative transfusion of at least one unit of RBC. The overall mortality was 8.7% (N = 5). During surgery 29.8% of the overall sample presented a decrease of more than 20% of baseline SrO2 or a value lower than 50%. Patients with a significant decrease in SrO2 presented a higher rate of perioperative complications (P=0.04) and longer ICU-LOS 4.3 (SD 3.6) vs. 6.8 (SD 8.2) days (P=0.01) and hospital LOS 10.1 (SD 3.1) vs. 14.2 (SD 9.4) days (P=0.01). Pretransfusional HB was 7.4 (SD 0.8) mg/dl and postransfusional value was 8.4 (SD 0.8) (P =0.00). Pretransfusional SrO2 was 59 (SD 8.6) and increased non- significantly after RBC transfusion to 61.1 (SD 7.9) (P=0.1). Only 6 patients out of 21 could be considered responders. There were no significant differences in morbidity, mortality or LOS between responders and non-responders.
Discussion:
In our population a non statistically significant increase in SrO2 was observed after RBC transfusion. When considering responders few patients were identified by SrO2. In conclusion SrO2 might not be reliable triger to decide transfusion.
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