Quality control of intraoperative autologous blood salvage in cardiac surgery

The management of intraoperative autologous blood salvage (ABS) quality is essential to ensure safety and outcomes; although publications on this subject are scarce. We evaluated a standardized program of ABS quality control for cardiac and evaluated surgery predictors of mortality in this population.

Data from a multicenter retrospective study conducted in 27 institutions from January 2021 to December 2023 were analyzed. The quality control of washed autologous red blood cell concentrates that were recovered and reinfused into the patients was assessed directly from the reinfusion bag. Main quality indicators were hematocrit between 50% and 75%; hemolysis level <0.8%; and residual protein <0.5 g/u.

A total of 424 patients and 225,814 mL of intraoperatively recovered washed autologous red blood cells were included, corresponding to 576.6 autologous units. We obtained compliant results in 94.6% for hematocrit, 98.3% for hemolysis levels, and 98.4% for residual protein. A total of 36 (8%) altered results were observed, with most cases (23% or 5.4%) related to hematocrit. Patients requiring homologous blood components were younger (p = .006), had lower body weights (congenital heart disease), were female (p <.001), had lower preoperative hematocrit and hemoglobin levels (p <.001), and experienced more intraoperative or perioperative complications (p <.05). The multivariable model yielded significant results for preoperative hemoglobin, hematocrit quality control, intrahospital complications, and blood units transfused.

ABS is essential for the blood conservation program in cardiac surgery. Preoperative anemia, altered quality control, the need for homologous blood transfusion, and the occurrence of clinical and surgical complications impact patient outcomes.