Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery

Adrianus J. de Vries (Corresponding author), Wytze J. Vermeijden, L. Joost van Pelt, Edwin R. van den Heuvel, Willem van Oeveren

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Several authors and manufacturers of cell salvage devices recommend additional filtering of processed blood before transfusion. There is no evidence to support this practice. Therefore, we compared the clinical outcome and biochemical effects of cell salvage with or without additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled for coronary artery bypass grafting, valve replacement, or combined procedures were part of our randomized multicenter factorial study of cell salvage and filter use on transfusion requirements (ISRCTN 58333401). They were randomized to intraoperative cell salvage or cell salvage plus additional WBC depletion filter. We compared the occurrence of major adverse events (combined death/stroke/myocardial infarction) as primary outcome and minor adverse events (renal function disturbances, infections, delirium), ventilation time, and length of stay in the intensive care unit and hospital. We also measured biochemical markers of organ injury and inflammation. RESULTS: One hundred eighty-nine patients had cell salvage, and 175 patients had cell salvage plus filter and completed the study. Demographic data, surgical procedures, and amount of salvaged blood were not different between the groups. There was no difference in the primary outcome with a risk of 6.3% (95% confidence interval [CI], 3.34–11.25) in the cell salvage plus filter group versus 5.8% (95% CI, 3.09–10.45) in the cell salvage group, a relative risk of 1.08 (95% CI, 0.48– 2.43]. There were no differences in minor adverse events and biochemical markers between the groups. CONCLUSION: The routine use of an additional filter for transfusion of salvaged blood is unlikely to show important additional benefits.

Original languageEnglish
Pages (from-to)989-994
Number of pages6
JournalTransfusion
Volume59
Issue number3
DOIs
Publication statusPublished - Mar 2019

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Thoracic Surgery
Blood Cells
Equipment and Supplies
Confidence Intervals
Blood Transfusion
Biomarkers
Delirium
Coronary Artery Bypass
Multicenter Studies
Intensive Care Units
Ventilation
Length of Stay
Stroke
Myocardial Infarction
Demography
Inflammation
Kidney
Wounds and Injuries
Infection

Keywords

  • Aged
  • Blood Transfusion/methods
  • Cardiac Surgical Procedures/methods
  • Coronary Artery Bypass/methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction/surgery
  • Stroke/surgery
  • Treatment Outcome

Cite this

de Vries, Adrianus J. ; Vermeijden, Wytze J. ; van Pelt, L. Joost ; van den Heuvel, Edwin R. ; van Oeveren, Willem. / Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery. In: Transfusion. 2019 ; Vol. 59, No. 3. pp. 989-994.
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title = "Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery",
abstract = "BACKGROUND: Several authors and manufacturers of cell salvage devices recommend additional filtering of processed blood before transfusion. There is no evidence to support this practice. Therefore, we compared the clinical outcome and biochemical effects of cell salvage with or without additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled for coronary artery bypass grafting, valve replacement, or combined procedures were part of our randomized multicenter factorial study of cell salvage and filter use on transfusion requirements (ISRCTN 58333401). They were randomized to intraoperative cell salvage or cell salvage plus additional WBC depletion filter. We compared the occurrence of major adverse events (combined death/stroke/myocardial infarction) as primary outcome and minor adverse events (renal function disturbances, infections, delirium), ventilation time, and length of stay in the intensive care unit and hospital. We also measured biochemical markers of organ injury and inflammation. RESULTS: One hundred eighty-nine patients had cell salvage, and 175 patients had cell salvage plus filter and completed the study. Demographic data, surgical procedures, and amount of salvaged blood were not different between the groups. There was no difference in the primary outcome with a risk of 6.3{\%} (95{\%} confidence interval [CI], 3.34–11.25) in the cell salvage plus filter group versus 5.8{\%} (95{\%} CI, 3.09–10.45) in the cell salvage group, a relative risk of 1.08 (95{\%} CI, 0.48– 2.43]. There were no differences in minor adverse events and biochemical markers between the groups. CONCLUSION: The routine use of an additional filter for transfusion of salvaged blood is unlikely to show important additional benefits.",
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year = "2019",
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Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery. / de Vries, Adrianus J. (Corresponding author); Vermeijden, Wytze J.; van Pelt, L. Joost; van den Heuvel, Edwin R.; van Oeveren, Willem.

In: Transfusion, Vol. 59, No. 3, 03.2019, p. 989-994.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Additional filtering of blood from a cell salvage device is not likely to show important additional benefits in outcome in cardiac surgery

AU - de Vries, Adrianus J.

AU - Vermeijden, Wytze J.

AU - van Pelt, L. Joost

AU - van den Heuvel, Edwin R.

AU - van Oeveren, Willem

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: Several authors and manufacturers of cell salvage devices recommend additional filtering of processed blood before transfusion. There is no evidence to support this practice. Therefore, we compared the clinical outcome and biochemical effects of cell salvage with or without additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled for coronary artery bypass grafting, valve replacement, or combined procedures were part of our randomized multicenter factorial study of cell salvage and filter use on transfusion requirements (ISRCTN 58333401). They were randomized to intraoperative cell salvage or cell salvage plus additional WBC depletion filter. We compared the occurrence of major adverse events (combined death/stroke/myocardial infarction) as primary outcome and minor adverse events (renal function disturbances, infections, delirium), ventilation time, and length of stay in the intensive care unit and hospital. We also measured biochemical markers of organ injury and inflammation. RESULTS: One hundred eighty-nine patients had cell salvage, and 175 patients had cell salvage plus filter and completed the study. Demographic data, surgical procedures, and amount of salvaged blood were not different between the groups. There was no difference in the primary outcome with a risk of 6.3% (95% confidence interval [CI], 3.34–11.25) in the cell salvage plus filter group versus 5.8% (95% CI, 3.09–10.45) in the cell salvage group, a relative risk of 1.08 (95% CI, 0.48– 2.43]. There were no differences in minor adverse events and biochemical markers between the groups. CONCLUSION: The routine use of an additional filter for transfusion of salvaged blood is unlikely to show important additional benefits.

AB - BACKGROUND: Several authors and manufacturers of cell salvage devices recommend additional filtering of processed blood before transfusion. There is no evidence to support this practice. Therefore, we compared the clinical outcome and biochemical effects of cell salvage with or without additional filtering. STUDY DESIGN AND METHODS: The patients, scheduled for coronary artery bypass grafting, valve replacement, or combined procedures were part of our randomized multicenter factorial study of cell salvage and filter use on transfusion requirements (ISRCTN 58333401). They were randomized to intraoperative cell salvage or cell salvage plus additional WBC depletion filter. We compared the occurrence of major adverse events (combined death/stroke/myocardial infarction) as primary outcome and minor adverse events (renal function disturbances, infections, delirium), ventilation time, and length of stay in the intensive care unit and hospital. We also measured biochemical markers of organ injury and inflammation. RESULTS: One hundred eighty-nine patients had cell salvage, and 175 patients had cell salvage plus filter and completed the study. Demographic data, surgical procedures, and amount of salvaged blood were not different between the groups. There was no difference in the primary outcome with a risk of 6.3% (95% confidence interval [CI], 3.34–11.25) in the cell salvage plus filter group versus 5.8% (95% CI, 3.09–10.45) in the cell salvage group, a relative risk of 1.08 (95% CI, 0.48– 2.43]. There were no differences in minor adverse events and biochemical markers between the groups. CONCLUSION: The routine use of an additional filter for transfusion of salvaged blood is unlikely to show important additional benefits.

KW - Aged

KW - Blood Transfusion/methods

KW - Cardiac Surgical Procedures/methods

KW - Coronary Artery Bypass/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/surgery

KW - Stroke/surgery

KW - Treatment Outcome

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U2 - 10.1111/trf.15130

DO - 10.1111/trf.15130

M3 - Article

C2 - 30610759

AN - SCOPUS:85059535126

VL - 59

SP - 989

EP - 994

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 3

ER -