The article, published in the Brazilian Journal of Cardiovascular Surgery, explores the use of intraoperative and postoperative blood cell salvage (BCS) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). This observational study aims to evaluate how BCS impacts key clinical parameters, including hemoglobin (Hb) and hematocrit (Ht) levels, red blood cell (RBC) transfusion needs, infection rates, and the length of postoperative hospital stay.
Conducted across three hospitals in Brazil, the study included 41 adult patients who met specific inclusion and exclusion criteria. They were divided into two groups: those who received BCS (n=21) and those who did not (n=20). All surgeries were performed by the same surgeon to ensure procedural consistency.
Background
Cardiac surgeries involving CPB often result in massive blood loss due to coagulation disturbances caused by hemodilution, heparin use, and surgical trauma. These complications frequently necessitate blood transfusions, which are associated with increased infection risks, extended hospitalization, and higher mortality rates. To counter these issues, the Patient Blood Management (PBM) program emphasizes minimizing transfusion needs by optimizing the patient’s own blood use—where BCS plays a central role.
Study Design and Methods
The BCS technique used in this study involved collecting shed blood during and immediately after surgery (within 24 hours), washing and filtering it, and reinfusing it back into the patient. This process aimed to minimize allogeneic blood transfusions, which are often linked to immunomodulatory effects and higher rates of complications.
Data was collected at three time points—preoperatively, immediately postoperatively (IPO), and at hospital discharge (HD)—for Hb and Ht levels. Other variables measured included the number of RBC units transfused postoperatively, infection rates, and the length of hospital stay.
Key Results
The findings clearly demonstrated the benefits of BCS use:
- Hemoglobin and Hematocrit: Patients in the BCS group had significantly higher IPO Hb (12.0 vs. 10.9 g/dL) and IPO Ht (35.7% vs. 30.7%), as well as higher Hb at hospital discharge (11.0 vs. 10.1 g/dL), indicating better hematological recovery.
- Red Blood Cell Transfusions: BCS use resulted in significantly fewer postoperative RBC transfusions (mean 0.0 units in BCS vs. 2.0 units in WBCS; P < 0.001).
- Infection Rates: The BCS group had substantially lower infection rates (4.8%) compared to the WBCS group (40%).
- Hospital Stay: Length of hospital stay was shorter in the BCS group (median 7 days) than the WBCS group (median 10 days).
Additionally, regression analysis showed that being in the WBCS group was an independent predictor of increased RBC use and longer hospital stay. Age, EuroSCORE II, and CPB time did not significantly affect outcomes.
Interpretation and Clinical Implications
The study’s data aligns with a growing body of evidence supporting PBM strategies. The use of BCS not only maintained more stable hematological parameters but also reduced the burden on hospital blood banks and lowered the risks associated with transfusions, such as infections and systemic inflammation.
Interestingly, the study also discusses the potential of BCS to reduce inflammatory complications commonly triggered by CPB and allogeneic transfusion. Prior studies have linked BCS use with lower levels of pro-inflammatory cytokines like interleukin-10 and better renal function markers, further reinforcing its clinical value.
Another compelling point raised is the underreported benefit of using BCS postoperatively via mediastinal drains. The ability to safely reinfuse blood from thoracic drains up to 24 hours post-surgery represents an opportunity to expand BCS utilization beyond the operating room.
Limitations
While promising, the study acknowledges limitations, including its non-randomized design and lack of inflammatory marker analysis. These factors suggest a need for larger, randomized controlled trials to confirm these findings and explore additional benefits of BCS.
Conclusion
This study makes a strong case for incorporating BCS into routine cardiac surgical practice as part of PBM strategies. The consistent improvements in hematologic parameters, infection rates, and hospital stay highlight its potential to transform perioperative care. With growing concerns over blood supply limitations and the risks of transfusion, BCS emerges as a safe, effective, and economically viable solution.
