Jennifer L Vance, Lisa Irwin, Elizabeth S Jewell, Milo Engoren
Department of Anesthesiology, University of Michigan, USA
Background: Transfusion rates in cardiac surgery are high.
Aim: To determine if intraoperative autologous blood removal without volume replacement is associated with fewer homologous blood transfusions without increasing acute kidney injury.
Setting and Design: Retrospective, comparative study.
Materials and Methods: Adult patients undergoing cardiac surgery, excluding those who underwent ventricular assist device surgery, heart transplants, or cardiac surgery without cardiopulmonary bypass were excluded, who had 1–3 units of intraoperative autologous blood removal were compared to patients without blood removal for determination of volume replacement, vasopressor support, acute kidney injury, and transfusions.
Results: Autologous blood removal was associated with fewer patients receiving homologous transfusions: intraoperative red cell transfusions fell from 75% (Control) to 48% (1 unit removed), 40% (2 units), and 30% (3 units), P < 0.001. Total intraoperative and postoperative homologous RBC units transfused were lower in the blood removal groups: median (interquartile range) 3 (1, 6) in Control patients and 0 (0, 2), 0 (0, 2) and 0 (0, 1) in the 1, 2, and 3 units removed groups, P < 0.001. Similarly, plasma, platelet, and cryoprecipitate transfusions decreased. After adjustment for confounders, increased amounts of autologous blood removal were associated with increased intravenous fluids, only when 2 units were removed, and trivially increased vasopressor use. However, it was not associated with acidosis or acute kidney injury.
Conclusions: Intraoperative autologous blood removal without volume replacement of 1–3 units for later autologous transfusion is associated with decreased homologous transfusions without acidosis or acute kidney injury.
Department of Anesthesiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI - 48106
Source of Support: None, Conflict of Interest: None
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