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
OBJECTIVE:
: To 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.
DESIGN:
: Prospective, randomized, controlled, clinical trial.
SETTING:
: Pediatric cardiac intensive care unit.
PATIENTS:
: Infants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass.
INTERVENTIONS:
:
Subjects 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 RESULTS:
:
Children 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.
CONCLUSION:
: Cell 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.
