Key result
Intra-operative cell salvage increases blood coagulation impairment by ~14 percentage points vs. standard care.
Why the study?
Intra-operative cell salvage was reported not to impair blood coagulation in low-bleeding-risk cardiac surgery with cardiopulmonary bypass, but studies in high-bleeding-risk cardiac surgery were limited.
Does intra-operative cell salvage impair blood coagulation and increase postoperative bleeding compared to no cell salvage in high-bleeding-risk patients undergoing cardiac surgery with cardiopulmonary bypass?
RCT (n=110)
Open-label (double-blind method was not adopted)
1:1 randomization according to a randomization list
No
Does intra-operative cell salvage impair blood coagulation and increase postoperative bleeding compared to no cell salvage in high-bleeding-risk patients undergoing cardiac surgery with cardiopulmonary bypass?
Answers are grounded in this paper and cite their sources.
In high-bleeding-risk cardiac surgery with cardiopulmonary bypass, intra-operative cell salvage reduces allogeneic RBC transfusion needs but significantly increases residual heparin, perioperative coagulopathy, and postoperative excessive bleeding, warranting careful TEG monitoring.
BACKGROUND: Intra-operative cell salvage (CS) was reported to have no impairment on blood coagulation in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the impact of CS on blood coagulation in high-bleeding-risk cardiac surgery with CPB. METHODS: One hundred and ten patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints included the incidence of impairment of blood coagulation during perioperative period (peri-op) and the incidence of adverse events during postoperative period (post-op). Peri-op was defined as the period from beginning of anesthesia (anesthesia induction) to 24 h after end of surgery. Post-op was defined as the period from the end of surgery to 24 h after end of surgery. The types of impairment of blood coagulation included heparin residual, coagulopathy due to low PLT, coagulopathy due to low FIB, coagulopathy due to low coagulation factors, hyperfibrinolytic. The sum of above five types was total impairment of blood coagulation. Adverse events included excessive bleeding, resternotomy, etc. RESULTS: The incidence of heparin residual measured both at the end of surgery and during post-op were significantly higher in Group CS than in Group C (15.09 vs 4.00, 13.21 vs 2.00 %; p = 0.024, 0.010, respectively). Similarly, the incidence of total impairment of blood coagulation at the end of surgery and during post-op were significantly higher in Group CS than in Group C (32.08 vs 18.00, 26.42 vs 12.00 %; p = 0.043, 0.040, respectively). The incidence of excessive bleeding during post-op was 32.08 % in Group CS compared with 16.00 % in Group C (p = 0.038). Intriguingly, CS was associated with a significantly increase in the relative risk ratios for heparin residual and excessive bleeding (p = 0.034, 0.049, respectively). CONCLUSIONS: Intra-operative CS could impair blood coagulation in the scenario of high-risk-bleeding cardiac surgery with CPB.
No takes yet. Share an insight, caveat, or question.
Shen et al. (2016) conducted an RCT in High-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB) (n=110). Intra-operative cell salvage (CS) vs. Control group without intra-operative cell salvage (shed blood during non-heparinization and residual CPB circuit blood were discarded; both groups received tranexamic acid 30 mg/kg) was evaluated on Incidence of total impairment of blood coagulation (sum of heparin residual, coagulopathy due to low PLT, low FIB, low coagulation factors, and hyperfibrinolysis) at the end of surgery (p=0.043). Intra-operative cell salvage significantly increased total blood coagulation impairment at the end of surgery (32.08% vs 18.00%, p=0.043) and postoperatively (26.42% vs 12.00%, p=0.040).
Synapse has enriched 10 related papers. Consider them for comparative context: