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(Circulation. 2007;116:I-89 – I-97.)
© 2007 American Heart Association, Inc.

Myocardial Protection, Perioperative Management, and Vascular Biology

The Cardiotomy Trial

A Randomized, Double-Blind Study to Assess the Effect of Processing of Shed Blood During Cardiopulmonary Bypass on Transfusion and Neurocognitive Function

Fraser D. Rubens, MD, MSc, FRCS(C); Munir Boodhwani, MD, MMSc; Thierry Mesana, MD, PhD; Denise Wozny, BA; George Wells, PhD; Howard J. Nathan, MD, on behalf of the Cardiotomy Investigators

From the Divisions of Cardiac Surgery (F.D.R., M.B., T.M.) and Cardiac Anesthesia (D.W., H.J.N.) and the Department of Epidemiology and Community Medicine (G.W.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Correspondence to Fraser D. Rubens, MD, MSc, FRCS(C), H3401, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada. E-mail frubens{at}ottawaheart.ca

Background— Reinfusion of unprocessed cardiotomy blood during cardiac surgery can introduce particulate material into the cardiopulmonary bypass circuit, which may contribute to postoperative cognitive dysfunction. On the other hand, processing of this blood by centrifugation and filtration removes coagulation factors and may potentially contribute to coagulopathy. We sought to evaluate the effects of cardiotomy blood processing on blood product use and neurocognitive functioning after cardiac surgery.

Methods and Results— Patients undergoing coronary and/or aortic valve surgery using cardiopulmonary bypass were randomized to receive unprocessed blood (control, n=134) or cardiotomy blood that had been processed by centrifugal washing and lipid filtration (treatment, n=132). Patients and treating physicians were blinded to treatment assignment. A strict transfusion protocol was followed. Blood transfusion data were analyzed using Poisson regression models. The treatment group received more intraoperative red blood cell transfusions (0.23±0.69 U versus 0.08±0.34 U, P=0.004). Both red blood cell and nonred blood cell blood product use was greater in the treatment group and postoperative bleeding was greater in the treatment group. Patients were monitored intraoperatively by transcranial Doppler and they underwent neuropsychometric testing before surgery and at 5 days and 3 months after surgery. There was no difference in the incidence of postoperative cognitive dysfunction in the 2 groups (relative risk: 1.16, 95% CI: 0.86 to 1.57 at 5 days postoperatively; relative risk: 1.05, 95% CI: 0.58 to 1.90 at 3 months). There was no difference in the quality of life nor was there a difference in the number of emboli detected in the 2 groups.

Conclusions— Contrary to expectations, processing of cardiotomy blood before reinfusion results in greater blood product use with greater postoperative bleeding in patients undergoing cardiac surgery. There is no clinical evidence of any neurologic benefit with this approach in terms of postoperative cognitive function.

Key Words: nervous system • cardiopulmonary bypass • trials • hemorrhage • surgery