Cell Saver for On-pump Coronary Operations Reduces Systemic Inflammatory Markers: A Randomized Trial

• Published in: The Annals of thoracic surgery Vol. 89; no. 5; pp. 1511 - 1517
• Main Authors: Damgaard, Sune, MD, PhD, Nielsen, Claus H., MD, PhD, Andersen, Lars W., MD, DMSc, Bendtzen, Klaus, MD, DMSc, Tvede, Michael, MD, Steinbrüchel, Daniel A., MD, DMSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2010; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Transfusion, Autologous - methods; Calcitonin - blood; Calcitonin Gene-Related Peptide; Cardiology. Vascular system; Cardiopulmonary Bypass - methods; Cardiothoracic Surgery; Coronary Artery Bypass - methods; Coronary Disease - mortality; Coronary Disease - surgery; Coronary heart disease; Female; Follow-Up Studies; Heart; Humans; Inflammation Mediators - blood; Interleukins - blood; Intraoperative Care - methods; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Complications - blood; Postoperative Complications - mortality; Probability; Prospective Studies; Protein Precursors - blood; Reference Values; Risk Assessment; Statistics, Nonparametric; Surgery; Survival Analysis; Survival Rate; Treatment Outcome; Tumor Necrosis Factor-alpha - blood; PCT; 25; European System for Cardiac Operative Risk Evaluation; NSAID; myocardial infarction; low molecular weight heparin; procalcitonin; interquartile range; non-steroidal anti-inflammatory drug; red blood cell; FFP; fresh frozen plasma; SD; percutaneous coronary intervention; RBC; tumor necrosis factor alpha; cardiopulmonary bypass; intensive care unit; interleukin; MI; coronary artery bypass grafting; sTNF-RI and -RII; CKMB; IL; IQR; activated coagulation time; soluble tumor necrosis factor receptor I and II; creatine kinase MB; LMWH; ACT; CPB; TNF-α; ITA; PCI; EuroSCORE; ICU; internal thoracic artery; CABG; COPD; chronic obstructive pulmonary disease; standard deviation; Coronary artery; Biological marker; Cardiovascular disease; Systemic; Operation; Coronary heart disease; Pump; Randomization; Treatment; Surgery; Anesthesia; Circulatory system; Disseminated; Cardiology; Cell
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.02.003

Background This study investigated whether intraoperative use of a cell saver reduces the systemic inflammatory response after coronary operations using cardiopulmonary bypass (CPB). Methods The study randomized 29 patients, 15 to cell saving of pericardial suction blood and residual blood in the CPB circuit after perfusion (cell saver group) vs 14 who received direct retransfusion of the suction blood and the CPB circuit blood (control group). Outcome measures were plasma concentrations of the inflammatory markers interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, soluble tumor necrosis factor receptors I and II, and procalcitonin at 6, 24, and 72 hours postoperatively. Results At 6 hours postoperatively, the cell saver group displayed significantly reduced plasma levels of IL-6 and IL-8 ( p < 0.05). A reduction in IL-10 was also found ( p = 0.05), along with nonsignificant reductions in the remaining markers. At 24 and 72 hours, significant differences between groups no longer existed. In the cell saver group, the suction blood and CPB circuit blood were cleared for tumor necrosis factor receptors ( p < 0.005), and IL-6, IL-8, IL-10, and procalcitonin were significantly reduced ( p < 0.05). Median intraoperative blood loss was 250 mL in the cell saver group vs 475 mL ( p < 0.02). Immediately postoperatively the hemoglobin level was higher in the cell saver group ( p < 0.03). Transfusion requirements were similar. Conclusions The cell saver reduced the systemic levels of the proinflammatory markers IL-6 and IL-8 at 6 hours after CPB. The role of the anti-inflammatory molecules IL-10 and soluble tumor necrosis factor receptors is undefined in this setting.