Department of Pediatrics, University of Rochester, Rochester, NY, USA.
Pediatr Crit Care Med. 2013 Feb;14(2):137-47. doi: 10.1097/PCC.0b013e31826e741c.
To evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hrs, would decrease the number of postoperative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes.
Prospective, randomized, controlled, clinical trial.
Pediatric cardiac intensive care unit.
Infants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass.
Subjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hrs after collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups.
Children randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 vs. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hrs post-op (cell saver: 0.09 ± 0.45 vs. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 vs. control: 2.3 ± 4.8; p = 0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 vs. control: 1.1 ± 1.4; p = 0.07). There were no significant clinical outcome differences.
Cell saver blood can be safely stored at the bedside for immediate transfusion for 24 hrs after collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate postoperative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease postoperative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.
评估在床边储存并保存长达 24 小时的细胞保存器回输是否可以减少术后异体红细胞输血和供者暴露的数量，并可能改善临床结果。
前瞻性、随机、对照、临床试验。
儿科心脏重症监护病房。
体重小于 20kg 的婴儿（n=106），因心脏手术需要体外循环。
将患者随机分为细胞保存器输血组，其中细胞保存器血液在收集后 24 小时内可用于输血，或对照组。细胞保存器组接受细胞保存器血液进行容量替代和/或红细胞输血。对照组接受晶体液或白蛋白进行容量替代和红细胞输血治疗贫血。比较两组之间的血液制品输血、供者暴露和临床结果。
随机分配到细胞保存器组的儿童在术后前 48 小时内接受的红细胞输血（细胞保存器：0.19±0.44 比对照组：0.75±1.2；p=0.003）和凝血产品输血明显减少（细胞保存器：0.09±0.45 比对照组：0.62±1.4；p=0.013），并且供者暴露明显减少（细胞保存器：0.60±1.4 比对照组：2.3±4.8；p=0.019）。这种差异持续到术后第一周，但没有达到统计学意义（细胞保存器：0.64±1.24 比对照组：1.1±1.4；p=0.07）。没有明显的临床结局差异。
细胞保存器血液可以在床边安全储存，收集后可立即输血 24 小时。使用细胞保存器血液可以显著减少术后即刻红细胞和凝血产品输血以及供者暴露的数量。减少血液制品输血有可能减少与输血相关的并发症并降低术后发病率。需要进行更大规模的研究以确定这种输血策略是否会改善临床结果。
