Hematologic evaluation of intraoperative autologous blood collection and allogeneic transfusion in cardiac surgery.
Henderson RA; Division of Cardiovascular Anesthesia, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Judd M; Division of Cardiovascular Anesthesia, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Strauss ER; Division of Cardiovascular Anesthesia, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Gammie JS; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Mazzeffi MA; Division of Cardiovascular Anesthesia, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Taylor BS; Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Tanaka KA; Division of Cardiovascular Anesthesia, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Transfusion [Transfusion] 2021 Jan 10. Date of Electronic Publication: 2021 Jan 10.
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Original Publication: Arlington, Va. : American Association Of Blood Banks
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Grant Information :
The study was supported in part by the research grant (RAH) from the Society for the Advancement of Blood Management (SABM)
Contributed Indexing :
Keywords: acute normovolemic hemodilution; allogeneic blood transfusion; autologous whole blood collection; blood conservation; cardiac surgery; intraoperative autologous blood donation; thromboelastometry
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Date Created: 20210110 Latest Revision: 20210110
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Background: Acute normovolemic hemodilution is recommended as a technique to reduce allogeneic red blood cell (RBC) transfusions in cardiac surgery, but its efficacy to reduce non-RBC transfusion has not been consistently demonstrated. We hypothesized that intraoperative large-volume autologous whole blood (AWB) collection and reinfusion improves viscoelastic coagulation parameters.
Study Design and Methods: Prospective observational study of cardiac surgery patients at the University of Maryland Medical Center between December 2017 and August 2019. Rotational thromboelastometry parameters were compared between AWB and control groups (n = 25 in each group) at three time points: T1, baseline; T2, on cardiopulmonary bypass (CPB) after the cross-clamp removal; and T3, 30-60 minutes after protamine administration. The study's primary outcomes were whole blood viscoelastic coagulation parameters that included EXTEM clotting time (CT), FIBTEM amplitude at 10 minutes, and EXTEM amplitude at 10 minutes (EXTEM-A 10 ). Chest tube drainage and allogeneic transfusion were secondary outcomes.
Results: Reinfusion of AWB after CPB resulted in a significantly shorter EXTEM CT; mean difference, -11.4 seconds (-21.4 to -1.4; P = .03). It also resulted in a greater percentage increase in EXTEM A 10 from T2 to T3; mean difference, 7.8% (95% CI, 1.1%-14.5%; P = .02). Statistical significance was not found in 24-hour chest tube drainage.
Conclusion: Large-volume AWB collection and reinfusion are feasible in selected cardiac surgical patients, and may be associated with prohemostatic effects according to thromboelastometry, warranting further investigation with a prospective randomized study.
(© 2021 AABB.)