Abstract
Background
Manufacturers of cell salvage devices also recommend a 40µm microfilter or a leukocyte depletion filter. Several authors use [1] and advocate [2] the use of an additional filter when retransfusing processed cell saver blood to the patient. And lastly, the AABB guidelines recommend use of a leukocyte depletion filter when fat is suspected in the processed cell saver blood [3]. There is however only anecdotical evidence for this recommendation. In this study, part of a larger trial (ISRCTN 58333401)[4], we analysed the specific effect of an additional leukocyte depletion filter (Biofil 2, Fresenius, Germany) for processed cell saver blood on clinical outcomes and biochemical markers after cardiac surgery.
Methods
Patients scheduled for on pump-coronary bypass grafting, valve replacement or combined procedures were randomized to either intraoperative cell salvage alone (CS) or cell salvage plus leukocyte depletion filter (CS+F). We measured the postoperative occurrence of major clinical adverse events (combined stroke/myocardial infarction, renal function disturbances, infections, delirium, ventilation times, and lenght of stay in the ICU and hospital. We also measured biochemical markers of inflammation (leukocytes, interleukin-6, myeloperoxidase, elastase and C-reactive protein (CRP)) on the first and second postoperative day.
Results
189 patients in the CS group and 175 patients in the CS+F group completed the study. Demographic data, aortic cross clamp times (65±27 min vs 67±29 min) and surgical procedures were not different across the two groups. The amount of processed cell saver blood was likewise not different (658±390 mL vs 684±514 mL). There was also no difference in postoperative ventilation times (16.0 ± 23.9 hrs vs. 14.9 ± 16.4 hrs), length of stay in the ICU (1.9± 5.6 days vs. 1.7± 2.4 days) or in the hospital (11.5 ± 10.5 days vs. 10.3 ± 7.8 days, p=0.06). Major adverse outcomes are shown in table 1 and biochemical results in table 2.
Discussion
We used a leukocyte depletion filter, which is regarded as a better filter than a 40µm microfilter. We hypothesized that this would thus result in the greatest differences if there were any. However, we found none. Given the similarities in clinical outcome and biochemical measurements we therfore conclude that there is no evidence to support the use of an additional filter for retransfusion of processed cell saver blood in routine cardiac surgery.
Manufacturers of cell salvage devices also recommend a 40µm microfilter or a leukocyte depletion filter. Several authors use [1] and advocate [2] the use of an additional filter when retransfusing processed cell saver blood to the patient. And lastly, the AABB guidelines recommend use of a leukocyte depletion filter when fat is suspected in the processed cell saver blood [3]. There is however only anecdotical evidence for this recommendation. In this study, part of a larger trial (ISRCTN 58333401)[4], we analysed the specific effect of an additional leukocyte depletion filter (Biofil 2, Fresenius, Germany) for processed cell saver blood on clinical outcomes and biochemical markers after cardiac surgery.
Methods
Patients scheduled for on pump-coronary bypass grafting, valve replacement or combined procedures were randomized to either intraoperative cell salvage alone (CS) or cell salvage plus leukocyte depletion filter (CS+F). We measured the postoperative occurrence of major clinical adverse events (combined stroke/myocardial infarction, renal function disturbances, infections, delirium, ventilation times, and lenght of stay in the ICU and hospital. We also measured biochemical markers of inflammation (leukocytes, interleukin-6, myeloperoxidase, elastase and C-reactive protein (CRP)) on the first and second postoperative day.
Results
189 patients in the CS group and 175 patients in the CS+F group completed the study. Demographic data, aortic cross clamp times (65±27 min vs 67±29 min) and surgical procedures were not different across the two groups. The amount of processed cell saver blood was likewise not different (658±390 mL vs 684±514 mL). There was also no difference in postoperative ventilation times (16.0 ± 23.9 hrs vs. 14.9 ± 16.4 hrs), length of stay in the ICU (1.9± 5.6 days vs. 1.7± 2.4 days) or in the hospital (11.5 ± 10.5 days vs. 10.3 ± 7.8 days, p=0.06). Major adverse outcomes are shown in table 1 and biochemical results in table 2.
Discussion
We used a leukocyte depletion filter, which is regarded as a better filter than a 40µm microfilter. We hypothesized that this would thus result in the greatest differences if there were any. However, we found none. Given the similarities in clinical outcome and biochemical measurements we therfore conclude that there is no evidence to support the use of an additional filter for retransfusion of processed cell saver blood in routine cardiac surgery.
| Original language | English |
|---|---|
| Pages | A3046 |
| Publication status | Published - 26-Oct-2015 |
| Event | ANESTHESIOLOGY 2015 annual meeting - San Diego, United States Duration: 24-Oct-2015 → 28-Oct-2015 https://www.asahq.org/annualmeeting/ |
Conference
| Conference | ANESTHESIOLOGY 2015 annual meeting |
|---|---|
| Country/Territory | United States |
| City | San Diego |
| Period | 24/10/2015 → 28/10/2015 |
| Internet address |