Bhatt Himani V, Hu Young, Lin Hung-Mo, Egorova Natalia, Ouyang Yuxia, Levin Matthew A
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Family Medicine, Stamford Hospital/Columbia University, Stamford, CT.
J Cardiothorac Vasc Anesth. 2025 May;39(5):1173-1179. doi: 10.1053/j.jvca.2025.01.035. Epub 2025 Jan 30.
Hemoconcentration and cell saver use are blood conservation techniques that are often used in cardiac surgery to salvage the patient's own blood to reduce autologous transfusion. The purpose of this study was to examine the perioperative outcomes including transfusion rates in cardiac surgical patients receiving hemoconcentrated blood versus cell saver blood via retrospective chart review. We hypothesized that hemoconcentration would have better patient outcomes, including reduced transfusion rates, compared to only cell salvage technique.
Single-center, retrospective chart review case-control study SETTING: Cardiac operating room of a tertiary care center PARTICIPANTS: Patients over 18 years old who underwent elective open-heart surgery with cardiopulmonary bypass between January 2015 to January 2018. Patients for emergencies, off-pump cases, transplants, and reoperations and with a need for second bypass were excluded.
None.
The specific outcomes assessed include perioperative transfusion of packed red blood cells and blood products, intensive care unit (ICU) length of stay, hospital length of stay, and surgical site infections. Patient characteristics such as ejection fraction and comorbidities, pulmonary hypertension, atrial fibrillation history, and coagulation dysfunction were also analyzed. Propensity score matching was done to balance the covariates between the groups. The differences for each outcome outlined above were calculated. Of the 744 observations, 735 were used for analysis after propensity matching. Postoperative ICU red blood cell transfusions recorded a mean difference of -0.37 (95% CI: -0.78, 0.04). Postoperative ICU platelets and fresh frozen plasma recorded mean differences of -0.01 (95% CI: -0.11, 0.09) and -0.08 (95% CI: -0.19, 0.03), respectively. There were no significant differences in outcomes in bivariate- and covariate-adjusted models.
There is no significant difference in postoperative blood transfusion rates in hemoconcentrated versus cell saver blood usage in cardiac surgery patients. Further studies are needed to analyze specific quantities and ratios of hemoconcentrated and cell saver blood used in these patients for a more clinically relevant analysis. This would allow incorporation of hemoconcentration and cell saver techniques into better blood conservation processes and guide overall transfusion strategies to reduce transfusion rates of blood and blood products in cardiac surgical patients.
血液浓缩和细胞回收器的使用是血液保护技术，常用于心脏手术中挽救患者自身血液以减少自体输血。本研究的目的是通过回顾性病历审查，检查接受血液浓缩血液与细胞回收器血液的心脏手术患者的围手术期结局，包括输血率。我们假设与仅采用细胞回收技术相比，血液浓缩将使患者获得更好的结局，包括降低输血率。
单中心回顾性病历审查病例对照研究
三级医疗中心的心脏手术室
2015年1月至2018年1月期间接受择期体外循环心脏直视手术的18岁以上患者。排除急诊患者、非体外循环手术患者、移植患者、再次手术患者以及需要二次体外循环的患者。
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评估的具体结局包括围手术期浓缩红细胞和血液制品的输血情况、重症监护病房（ICU）住院时间、住院时间以及手术部位感染。还分析了患者特征，如射血分数和合并症、肺动脉高压、房颤病史和凝血功能障碍。进行倾向评分匹配以平衡两组之间的协变量。计算上述每个结局的差异。在744例观察对象中，735例在倾向评分匹配后用于分析。术后ICU红细胞输血的平均差异为-0.37（95%CI：-0.78，0.04）。术后ICU血小板和新鲜冰冻血浆的平均差异分别为-0.01（95%CI：-0.11，0.09）和-0.08（95%CI：-0.19，0.03）。在双变量和协变量调整模型中，结局无显著差异。
心脏手术患者使用血液浓缩血液与细胞回收器血液的术后输血率无显著差异。需要进一步研究分析这些患者使用的血液浓缩血液和细胞回收器血液的具体数量和比例，以进行更具临床相关性的分析。这将有助于将血液浓缩和细胞回收技术纳入更好的血液保护流程，并指导总体输血策略，以降低心脏手术患者的血液和血液制品输血率。
