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

摘要

PatientsOperationCell Saver and SuctionTrial DesignBlood Samples and AnalyzesStatistical AnalysisResultsPatient InclusionGroup Cytokine ProfilesCell Saver EffectivenessBlood Loss and TransfusionsMedication and ComplicationsCommentGroup Cytokine ProfilesCell Saver EffectivenessBlood Loss and TransfusionsComplicationsAlternative MethodsOther Cell Saver TrialsLimitationsConclusionsReferencesThis study investigated whether intraoperative use of a cell saver reduces the systemic inflammatory response after coronary operations using cardiopulmonary bypass (CPB).MethodsThe 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.ResultsAt 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.ConclusionsThe 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.Abbreviations and Acronyms: ACT (activated coagulation time), CABG (coronary artery bypass grafting), CKMB (creatine kinase MB), COPD (chronic obstructive pulmonary disease), CPB (cardiopulmonary bypass), EuroSCORE (European System for Cardiac Operative Risk Evaluation), FFP (fresh frozen plasma), ICU (intensive care unit), IL (interleukin), IQR (interquartile range), ITA (internal thoracic artery), LMWH (low molecular weight heparin), MI (myocardial infarction), NSAID (non-steroidal anti-inflammatory drug), PCI (percutaneous coronary intervention), PCT (procalcitonin), RBC (red blood cell), SD (standard deviation), sTNF-RI and -RII (soluble tumor necrosis factor receptor I and II), TNF-α (tumor necrosis factor alpha)CTSNet classification:25Cardiopulmonary bypass (CPB) is a potent inducer of the systemic inflammatory response in patients undergoing cardiac operations. The passage of blood through the extracorporeal circulation and the foreign surface contact are the main immunologic activators of white blood cells, monocytes, and platelets. Depending on the severity, this can lead to cerebral, myocardial, pulmonary, and renal dysfunction. Rarely, and in the worst case, acute lung injury, shock, renal failure, and multiple organ dysfunction syndrome might follow. The surgical trauma, hypothermia, ischemia-reperfusion injury, and endotoxemia caused by intestinal ischemia are prominent contributing factors to the systemic inflammatory response [