• Ann. Thorac. Surg. · Jan 2015

    Randomized Controlled Trial Multicenter Study

    Effects of cell-saving devices and filters on transfusion in cardiac surgery: a multicenter randomized study.

    • Wytze J Vermeijden, Jan van Klarenbosch, Y John Gu, Massimo A Mariani, Wolfgang F Buhre, Thomas W L Scheeren, Johanna A M Hagenaars, M Erwin S H Tan, Jo S E Haenen, Leo Bras, Wim van Oeveren, Edwin R van den Heuvel, and Adrianus J de Vries.
    • Department of Intensive Care and Thorax Centre Twente, Medisch Spectrum Twente Enschede, Enschede, the Netherlands. Electronic address: j.vermeijden@mst.nl.
    • Ann. Thorac. Surg. 2015 Jan 1; 99 (1): 26-32.

    BackgroundCell-saving devices (CS) are frequently used in cardiac surgery to reduce transfusion requirements, but convincing evidence from randomized clinical trials is missing. Filtration of salvaged blood in combination with the CS is widely used to improve the quality of retransfused blood, but there are no data to justify this approach.MethodsTo determine the contribution of CS and filters on transfusion requirements, we performed a multicenter factorial randomized clinical trial in two academic and four nonacademic hospitals. Patients undergoing elective coronary, valve, or combined surgical procedures were included. The primary end point was the number of allogeneic blood products transfused in each group during hospital admission.ResultsFrom 738 included patients, 716 patients completed the study (CS+filter, 175; CS, 189; filter, 175; neither CS nor filter, 177). There was no significant effect of CS or filter on the total number of blood products (fraction [95% confidence interval]: CS, 0.96 [0.79, 1.18]; filter, 1.17 [0.96, 1.43]). Use of a CS significantly reduced red blood cell transfusions within 24 hours (0.75 [0.61,0.92]), but not during hospital stay (0.86 [0.71, 1.05]). Use of a CS was significantly associated with increased transfusions of fresh frozen plasma (1.39 [1.04, 1.86]), but not with platelets (1.25 [0.93, 1.68]). Use of a CS significantly reduced the percentage of patients who received any transfusion (odds ratio [95% confidence interval]: 0.67 [0.49, 0.91]), whereas filters did not (0.92 [0.68, 1.25]).ConclusionsUse of a CS, with or without a filter, does not reduce the total number of allogeneic blood products, but reduces the percentage of patients who need blood products during cardiac surgery.Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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