Intraoperative autotransfusion reduces blood loss after cardiopulmonary bypass

A combination of several techniques is necessary to minimize the transfusion requirements for open heart operations. The benefit of plasmapheresis remains in doubt because of smaller and less effective platelets obtained with this technique. Therefore, we evaluated the effects of whole blood intraoperative autotransfusion as part of a blood conservation protocol.

One hundred patients undergoing coronary artery bypass graft operations were randomized to an autotransfusion group (group A) or control group (group C). Group A patients had a 10 mL/kg of whole blood removed before cardiopulmonary bypass; they had retransfusion at the termination of cardiopulmonary bypass and heparin reversal. Both groups had intraoperative cell saving and autotransfusion of shed mediastinal blood postoperatively. The indications for blood transfusion were standardized, and the physicians ordering blood products were blinded to the study.

Compared with the control group, patients in the autotransfusion group had a 28% reduction of chest tube drainage at 8 hours and a 45% reduction in the total homologous blood units transfused.

Autotransfusion during cardiopulmonary bypass provides benefit in addition to other techniques in reducing blood loss and the need for blood products in the postoperative period.