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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 512-522, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RH Breyer, RM Engelman, JA Rousou and S Lemeshow
A total of 284 patients undergoing myocardial revascularization were
prospectively studied to determine if the use of intraoperative
autotransfusion or intraoperative autotransfusion plus postoperative
reinfusion of shed mediastinal blood decreased transfusion requirements and
the use of one or both techniques was cost effective. The Haemonetics Cell
Saver System was used for intraoperative autotransfusion and the Sorenson
Receptaseal autotransfusion system for postoperative reinfusion of shed
mediastinal blood. During Phase 1, the Cell Saver System was used for 57
patients and 93 patients served as a control group. During Phase 2, the
Cell Saver System plus the autotransfusion system were used in 43 patients
and 91 patients were in the control group. Separate parallel analyses to
compare the blood conservation groups to control groups were conducted for
each phase of the study. The patient groups were comparable with regard to
age, sex, preoperative red cell mass, preoperative hematocrit value, number
of bypasses, and use of internal mammary grafts. Blood conservation
techniques resulted in significant reductions in the use of bank blood.
During Phase 1, Cell Saver System patients received an average of 2.8 units
of packed cells versus 4.7 units for control patients. Transfusion was
avoided entirely in 14% of Cell Saver System patients compared to 3% of
control patients. During Phase 2, patients subjected to both the Cell Saver
System and the autotransfusion system received an average of 1 unit of
packed red cells versus 3 units for control patients. Transfusion was
required in only 42% of patients subjected to both the Cell Saver System
and the autotransfusion system compared to 85% of control patients.
Multiple logistic regression analysis confirmed that the use of the Cell
Saver System in Phase 1 and the Cell Saver System and autotransfusion
system in Phase 2 were each independently predictive of decreased
transfusion requirements. The total "blood-related costs" (including cost
for all bank blood products plus Receptaseal and Cell Saver System
equipment) was slightly lower for the blood conservation patients in both
Phase 1 ($555.00 versus $615.00, no significant difference) and Phase 2
($373.00 versus $426.00, no significant difference). Intraoperative use of
the Cell Saver System is associated with substantial savings of bank blood,
and the addition of postoperative reinfusion of shed mediastinal blood
results in further bank blood savings. The use of blood conservation
techniques is cost effective; that is, the costs incurred for the blood
conservation equipment are more than offset by the resultant dollar savings
for blood products.
ARTICLES
Blood conservation for myocardial revascularization. Is it cost effective?
This article has been cited by other articles:
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  L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom Transfusion Therapy and Blood Conservation Card. Surg. Adult, January 1, 2008; 3(2008): 415 - 430. [Full Text]
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 The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
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R. C. Arora, J.-F. Legare, K. J. Buth, J. A. Sullivan, and G. M. Hirsch Identifying Patients at Risk of Intraoperative and Postoperative Transfusion in Isolated CABG: Toward Selective Conservation Strategies Ann. Thorac. Surg., November 1, 2004; 78(5): 1547 - 1554. [Abstract] [Full Text] [PDF]
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L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom Transfusion Therapy and Blood Conservation Card. Surg. Adult, January 1, 2003; 2(2003): 389 - 400. [Full Text]
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R. Salenger, J. S. Gammie, and T. J. Vander Salm Postoperative Care of Cardiac Surgical Patients Card. Surg. Adult, January 1, 2003; 2(2003): 439 - 469. [Full Text]
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 M. Wilhelmi, U. Franke, T. Cohnert, P. Weber, J. Kaukemuller, S. Fischer, T. Wahlers, and A. Haverich Coronary artery bypass grafting surgery without the routine application of blood products: is it feasible? Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 657 - 661. [Abstract] [Full Text] [PDF]
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H. Schmidt, P. E. Mortensen, S. L. Folsgaard, and E. A. Jensen Autotransfusion After Coronary Artery Bypass Grafting Halves the Number of Patients Needing Blood Transfusion Ann. Thorac. Surg., April 1, 1996; 61(4): 1177 - 1181. [Abstract] [Full Text]
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Bo Liu, A. Belboul, S. Larsson, and D. Roberts Factors influencing haemostasis and blood transfusion in cardiac surgery Perfusion, March 1, 1996; 11(2): 131 - 143. [Abstract] [PDF]
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T. Sakert, W. Gil, I. Rosenberg, D. Carpellotti, K. Boss, T. Williams, J. Ferneding, and I. Christlieb Cell saver efficacy for routine coronary artery bypass surgery Perfusion, January 1, 1996; 11(1): 71 - 77. [Abstract] [PDF]
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E. Smith and Z. Rayter Postoperative autotransfusion of mediastinal blood: a review Perfusion, January 1, 1990; 5(1_suppl): 25 - 30. [PDF]
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