• Mark Alm, Margarita Otalora-Esteban, Natasha Bush, Amanda Dranfield, Keyvan Karkouti, and Brian Beairsto.
• Department of Perfusion Services, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. mark.alm@uhn.ca.
• Can J Anaesth. 2025 Feb 4.

PurposeWe sought to conduct a quality improvement initiative to compare the wash quality and speed of autologous red blood cell (RBC) processing of four autotransfusion devices during cardiac surgery.MethodsUsing a prospective observational cohort study approach, we prospectively evaluated four commercially available autologous cell savage devices (autoLog IQ™, Medtronic plc, Minneapolis, MN, USA [135 mL]; Xtra™, LivaNova, plc, Houston, TX, USA [125 mL, 225 mL]; Cell Saver® Elite®+, Haemonetics Corp., Boston, MA, USA [125 mL, 225 mL]; and CATSmart®, Fresenius Kabi AG, Bad Homburg vor der Höhe, Germany) in adult patients undergoing cardiac surgery. Device settings were determined by manufacturer recommendations for optimal wash quality. We collected pre- and postprocessing samples, volumes, and processing times from each device to calculate removal ratios of heparin, potassium, plasma free hemoglobin (PfHb), white blood cells (WBCs), platelets, reinfusion concentrations of heparin and potassium, and red blood cell (RBC) recovery rates.ResultsA total of 130 consecutive patients underwent autologous cell salvage, but 15 cases were excluded because of incomplete data. All devices removed > 99% heparin, > 95% potassium, > 94% platelets, and > 85% PfHb from collected shed blood. Comparison of processing sets showed significant differences in median [interquartile range] WBC removal ratios, ranging from 26 [19-33]% to 59 [42-68]%, and median heparin reinfusion concentrations, which ranged from 0.09 [0.08-0.11] to 0.63 [0.55-0.70] U·mL-1 processed red cells. Median RBC recovery rates also showed significant differences between processing sets, ranging from 8 [8-10] mL RBC·min-1 to 24 [22-25] mL RBC·min-1.ConclusionWash quality and processing speed differed between autotransfusion devices and processing sets. These findings may have clinical implications when large volumes of shed blood are processed and reinfused.© 2025. Canadian Anesthesiologists' Society.

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