• Kevin R Merkel, Sophia D Lin, Steven M Frank, Tymoteusz J Kajstura, Nicolas C Cruz, Brian D Lo, James H Black, Eric A Gehrie, Nadia B Hensley, Brian C Cho, and Laeben C Lester.
• Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.
• J. Cardiothorac. Vasc. Anesth. 2021 Apr 1; 35 (4): 1060-1066.

ObjectiveTo assess the ratio of non-red blood cell to red blood cell components required to avoid coagulopathy when transfusing large amounts of salvaged blood using laboratory test-guided therapy.DesignRetrospective cohort study.SettingSingle-center, academic hospital.ParticipantsThoracoabdominal and abdominal open aortic surgery patients.Measurement And Main ResultsThirty-eight patients in whom at least 1,000 mL of salvaged red blood cells were transfused were identified and divided into the following 2 cohorts: 1,000-to-2,000 mL of salvaged red blood cells (high dose) (n = 20) and >2,000 mL of salvaged red blood cells (ultra-high dose) (n = 18). Compared with the high-dose cohort, the ultra high-dose cohort received ∼4 times more salvaged red blood cells (1,240 ± 279 mL v 5,550 ± 3,801 mL). With transfusion therapy guided by intraoperative coagulation tests and thromboelastography, the adjusted ratio of non-red blood cell to red blood cell components (plasma + platelets + cryoprecipitate:allogeneic + salvaged red blood cells) was 0.59 ± 0.66 in the high-dose and 0.93 ± 0.27 in the ultra high-dose cohorts. Multiple coagulation parameters were normal and similar between cohorts at the end of surgery, as determined by the mean, median, and 95% confidence intervals.ConclusionsWhen transfusing large volumes of salvaged blood, it is important to balance the ratio between non-red blood cell and red blood cell components. Through a laboratory test-guided approach, coagulopathy was not detected when transfusing blood in ratios of approximately 1:2 for patients receiving 1,000-to-2,000 mL of salvaged blood and 1:1 for patients receiving >2,000 mL of salvaged blood.Copyright © 2020 Elsevier Inc. All rights reserved.

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