Efficacy of intraoperative blood salvage during coronary artery bypass grafting.

OBJECTIVE: To analyze the usefulness of autologous blood salvage and intraoperative isovolemic hemodilution in conjunction with autologous blood salvage in cardiac surgery, and also to compare two different autologous blood salvage methods.

EXPERIMENTAL DESIGN: Retrospective analysis of transfusion practice in cardiac surgery.

SETTING: University hospital.

PATIENTS: One hundred and sixty two consecutive patients who had coronary artery bypass grafting (CABG) from January to September, 1993.

INTERVENTIONS: A review of transfusion records of patients who underwent intraoperative autologous blood salvage and isovolemic hemodilution.

MEASURES: Perioperative transfusion requirements were analyzed in patients undergoing CABG using a cell saver system whereby blood was collected, processed and reinfused to the patients in the operating room.

RESULTS: Nineteen percent of patients did not receive perioperative homologous blood transfusion when a cell saver was used intraoperatively. When autologous isovolemic hemodilution was used in conjunction with a cell saver, fifty-four percent of the patients did not receive homologous blood transfusion. The results of this study were compared to matched patients undergoing CABG using a different type of cell saver system whereby blood was collected in the operating room, processed in the blood bank and reinfused in the intra- and/or postoperative period. We found that the former system provided a more timely and greater yield of blood salvaged and as a consequence, less homologous blood transfusion.

CONCLUSIONS: Intraoperative blood salvaging provides an immediate source of red blood cells and decreases the utilization of homologous blood. In addition, isovolemic hemodilution in conjunction with blood salvage further decreases homologous blood transfusion needs.