Abstract 2530: Processing Of Shed Mediastinal Blood Increases Post-operative Blood Product Use: A Randomized, Double-Blind Study
Background: Re-infusion of unprocessed shed mediastinal bood during cardiac surgery can contribute to increased inflammation as well as introduce particulate material into the bypass circuit. However, processing removes coagulation factors, augments fibrinolysis, and potentially contributes to coagulopathy. The aim of this study was to evaluate the effects of cardiotomy blood processing on blood product use and post-operative bleeding following cardiac surgery.
Methods: Patients undergoing coronary artery bypass and/or aortic valve surgery using cardiopulmonary bypass were randomized to receiving processed (treated, n = 132) or unprocessed shed blood (control, n = 134). For treated patients, cardiotomy blood was processed by centrifugation, washing, and additional filtration. Patients and treating physicians were blinded to treatment assignment, and strict transfusion and re-opening guidelines were followed. Intra- and post-operative red blood cell (RBC) and non-RBC transfusions as well as coagulation parameters were recorded. Blood transfusion data was analyzed using Poisson regression models.
Results: Intra-operatively, the treated group received more red blood cell transfusions (0.23 ± 0.69 vs. 0.08 ± 0.34 units/patient, p = 0.004). Two hours following surgery, partial thromboplastin time (38 ± 1.3s vs. 33 ± 0.6s, p = 0.001) and international normalized ratio (1.38 ± 0.02 vs. 1.31 ± 0.01, p = 0.04) were elevated in treated patients while haemoglobin, platelet count, and thrombin time were similar between groups. Re-exploration for bleeding was similar between groups (6.8% vs. 3.1%, control vs. treated, p = 0.25). As indicated in Table 1⇓, both RBC and non-RBC blood product use as well as post-operative bleeding was greater in the treated group.
Conclusions: Processing of shed mediastinal blood prior to re-infusion results in greater post-operative bleeding and increased RBC and non-RBC blood product use in patients undergoing cardiac surgery.