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Intraoperative cell salvage in infants undergoing elective cardiac surgery: a prospective trial

Department of Cardiothoracic Surgery and Department of Anaesthesiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Received 21 December 2007; received in revised form 25 April 2008; accepted 30 April 2008.

^_* Corresponding author. Address: Bd 467, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel.: +31 10 7035208. (Email: h.golab-schwarz{at}erasmusmc.nl).

Background: For a long time intraoperative cell salvage was considered not to be applicable in paediatric patients due to technical limitations. Recently, new autotransfusion devices with small volume centrifugal bowls and dedicated paediatric systems allow efficient blood salvage in small children. The purpose of this prospective non-randomised study was to determine the impact of intraoperative cell salvage on postoperative allogeneic blood products transfusion in infant patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Two consecutive cohorts (122 patients) were studied. The first cohort underwent procedures between January 2004 and July 2005 with only blood salvage from the residual volume. The second cohort consisted of patients operated on from August 2005 to December 2006, with additional use of intraoperative cell salvage. The following variables were analysed: peri- and postoperative blood loss, transfusion of homologous blood products and cell salvage product, haematological and coagulation data, measured before, during and after the operation. Results: Additional intraoperative cell salvage significantly enhanced the amount of cell saving product available for transfusion (183 ± 56 ml vs 152 ± 57 ml, p = 0.003) and significantly more patients in this group received the cell saving product postoperatively. Consequently, allogeneic blood transfusion was significantly reduced in volume as well as in frequency. We did not observe any adverse effects of intraoperative cell salvage. Conclusion: Intraoperative cell salvage, employed as an adjuvant technique to the residual volume salvage in infants undergoing first time cardiac surgery with cardiopulmonary bypass, was a safe and effective method to reduce postoperative allogeneic blood transfusion. Considering current cell salvage related expense and the cost reduction achieved by diminished allogeneic transfusion, intraoperative cell salvage in infants demonstrated no economic benefit.

Key Words: Congenital heart disease • Infant • Cardiopulmonary bypass • Cell-saver • Blood conservation