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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1001-1006, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WJ Scott, R Rode, B Castlemain, R Kessler, F Follis, SB Pett and JA Wernly
We reviewed blood use in 118 consecutive patients who underwent primary,
elective cardiac operations in 1989. In June 1989 we initiated a blood
conservation program that included attempts to limit preoperative aspirin
use, intraoperative phlebotomy and hemodilution, use of a cell conservation
device (Electromedics, Inc., Englewood, Colo.) to concentrate residual
oxygenator contents, reinfusion of chest drainage, and acceptance of a
minimum hemoglobin level of 8.0 gm/dl in stable patients. Patient
characteristics were similar for patients operated on both before (n = 58)
and after (n = 60) initiation of the blood conservation program, except for
age and preoperative aspirin use (both greater in postconservation
patients). Fewer blood products were transfused (5.8 +/- 5.7 units per
patient before conservation versus 4.0 +/- 7.4 units per patient after
conservation; p = 0.005). More complete data were available for 82 patients
(40 patients before conservation and 42 after conservation). In the
postconservation patients, 20 of 42 had 575 +/- 140 ml of blood withdrawn
before cardiopulmonary bypass and reinfused afterward, 26 of 42 had 806 +/-
376 ml of blood processed with the cell conservation device returned, and
21 of 42 patients had an average of 287 +/- 127 ml of chest drainage
reinfused. Chest tube drainage, postoperative hematologic parameters, and
the prevalence of complications were not significantly different between
groups. Stepwise linear regression analysis identified intraoperative
withdrawal of blood before cardiopulmonary bypass, bypass duration, and
preoperative hematocrit value as predictors of blood use. Intraoperative
withdrawal of blood before cardiopulmonary bypass is an important
conservation measure, and its use should be expanded.
ARTICLES
Efficacy, complications, and cost of a comprehensive blood conservation program for cardiac operations
Division of Cardiothoracic Surgery, Department of Veterans Affairs Medical Center, Albuquerque, N.M.
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