Departments of Cardio-thoracic Surgery, Institute for Cardiovascular Research, Amsterdam, Netherlands; Departments of Anesthesiology, Institute for Cardiovascular Research, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
Transfusion. 2013 Nov;53(11):2782-9. doi: 10.1111/trf.12126. Epub 2013 Feb 27.
This study investigated whether implementation of cell salvage of shed mediastinal and residual blood in all patients undergoing low-to-moderate-risk cardiac surgery reduces the need for allogeneic red blood cell (RBC) transfusion compared to patients not subjected to cell salvage.
This retrospective cohort study included patients undergoing low-to-moderate-risk cardiac surgery with cardiopulmonary bypass without (control; n = 531) or with cell salvage (n = 433; Autolog, Medtronic). Study endpoints, including 24-hour blood loss and RBC requirements, were evaluated using adjusted logistic regression.
Baseline characteristics were similar between groups. The cell saver group received 568 ± 267 mL of autologous blood. Median number of allogeneic RBC transfusions was higher in the control group (2 [1-5]) compared with the cell salvage group (1 [0-3]; p < 0.001). There were no clinically relevant differences in postoperative coagulation test results between groups. The relative risk (RR) for postoperative RBC transfusion was reduced to 0.76 (95% confidence interval [CI], 0.70-0.83; p < 0.0001) in the cell salvage group. Moreover, patients in the cell salvage group had a lower chance for myocardial infarction (RR, 0.26; 95% CI, 0.08-0.91; p = 0.035), whereas the cell salvage group was associated with a higher probability for intensive care discharge within 24 hours after surgery (RR, 1.08; 95% CI, 1.02-1.14; p = 0.009).
The use of cell salvage throughout the entire procedure reduces postoperative blood loss and allogeneic RBC transfusion. These findings advocate implementation of cell salvage in all patients undergoing on-pump cardiac surgery, irrespective of anticipated surgery-related blood loss.
本研究旨在探讨在接受中低危心脏手术的所有患者中实施回收术，与未接受回收术的患者相比，是否能减少同种异体红细胞（RBC）输注的需求。
本回顾性队列研究纳入了接受体外循环中低危心脏手术的患者（对照组：n=531；Autolog，美敦力公司组：n=433）。使用调整后的逻辑回归评估了包括 24 小时失血和 RBC 需求在内的研究终点。
两组患者的基线特征相似。回收组接受了 568±267mL 的自体血。对照组（2[1-5]）中同种异体 RBC 输注的中位数明显高于回收组（1[0-3]）（p<0.001）。两组术后凝血试验结果无显著差异。在回收组中，术后 RBC 输注的相对风险（RR）降低至 0.76（95%可信区间[CI]：0.70-0.83；p<0.0001）。此外，回收组心肌梗死的风险（RR，0.26；95%CI，0.08-0.91；p=0.035）较低，而术后 24 小时内转入重症监护病房的概率（RR，1.08；95%CI，1.02-1.14；p=0.009）较高。
在整个手术过程中使用回收术可减少术后失血和同种异体 RBC 输注。这些发现支持在所有接受体外循环心脏手术的患者中实施回收术，而与预计的手术相关失血无关。
