• Pediatr Crit Care Me · Feb 2013

    Randomized Controlled Trial

    Transfusion of cell saver salvaged blood in neonates and infants undergoing open heart surgery significantly reduces RBC and coagulant product transfusions and donor exposures: results of a prospective, randomized, clinical trial.

    • Jill M Cholette, Karen S Powers, George M Alfieris, Ronald Angona, Kelly F Henrichs, Debra Masel, Michael F Swartz, L Eugene Daugherty, Kevin Belmont, and Neil Blumberg.
    • Department of Pediatrics, University of Rochester, Rochester, NY, USA. Jill_Cholette@urmc.rochester.edu
    • Pediatr Crit Care Me. 2013 Feb 1; 14 (2): 137-47.

    ObjectiveTo evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hrs, would decrease the number of postoperative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes.DesignProspective, randomized, controlled, clinical trial.SettingPediatric cardiac intensive care unit.PatientsInfants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass.InterventionsSubjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hrs after collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups.Measurements And Main ResultsChildren randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 vs. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hrs post-op (cell saver: 0.09 ± 0.45 vs. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 vs. control: 2.3 ± 4.8; p = 0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 vs. control: 1.1 ± 1.4; p = 0.07). There were no significant clinical outcome differences.ConclusionCell saver blood can be safely stored at the bedside for immediate transfusion for 24 hrs after collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate postoperative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease postoperative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.

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