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Postoperative bleeding and autotransfusion

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Academic year: 2021

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Results : The CardioPAT® was used in 16 of the 361 interventions performed during the target period. Median postoperative bleeding volume was 202 (80-630)mL after 1 hour and 607 (247-1735) mL after 6 hours. The bleedings have allowed the use of the cell salvage option in 9 (56%) cases, with a median WRBC transfused volume of 280 (150-300)mL. Two patients required surgical re-exploration. All patients transfused by WRBC had previously received an allogeneic transfusion (RBC, FFP and/or PT). The hemoglobin level of blood collected with the CardioPAT® device impacted on the delay and the blood volume required for WRBC availability; the lower the hemoglobin level was, the larger the volume of blood required to obtain a concentrate of WRBC was. Consequently, patients with a very low hemoglobin level were transfused with RBC anyway.

Method : During a 6 months period, the CardioPAT® (Haemonetics) device was used postoperatively in all cardiac surgery patients at high risk of postoperative bleeding. The following data were prospectively collected: hemoglobin level, bleeding volume, volume of autologous washed red blood cell transfused by the CardioPAT® (WRBC), volume of allogeneic red blood cell (RBC), fresh frozen plasma (FFP) or platelets (PT) transfused and surgical re-exploration.

Introduction: Bleeding in the postoperative period of cardiac surgery is not rare. Mediastinal bleeding is usually collected in a chest drainage system and discarded. However, this blood could potentially be saved with a cell salvage device (CS) during the first six postoperative hours. This practice is generally performed only in case of a surgical re-exploration for massive bleeding and may contribute to decreased allogeneic transfusion. But in case of postoperative coagulopathy requiring medical treatment, re-exploration is usually postponed and consequently, the collected blood is discarded. Chest drainage systems combined with a cell salvage option could therefore optimize the management of blood losses and transfusions in the postoperative period, regardless of any surgical re-exploration. The aim of this study is to assess the effectiveness of such a system during the postoperative period of cardiac surgery, in patients at high risk of bleeding.

Postoperative bleeding and autotransfusion

M Erpicum

1

, F Blaffart

1

, J-O Defraigne

1

, R Larbuisson

1

.

1

University Hospital of Liège, Belgium

Conclusion : The use of the CardioPAT® device postoperatively can reduce allogeneic blood transfusion after cardiac surgery in patients at high risk of bleeding. It gives time to treat coagulopathy, leading to a decrease of surgical re-exploration. However, a device with a larger reservoir and a flexible processing speed would be more adapted in case of major haemorrhage. Systematic utilisation of this device at the time of FFP and/or PT transfusion is a safe but expensive strategy. It seems more adapted to use this device in a permissive bleeding strategy, waiting for the spontaneous coagulation recovery of the patient in the first postoperative hours.

Criteria for high risk of postoperative bleeding  CPB duration >150min

 >33% of the red blood cell mass treated by CS

 Postop bleeding + coagulopathy (TEG: R>14min and/or MA ≤40mm)  Postoperative bleeding >200mL/h during 3 hours

57%

22% 56% 22%

No WRBC (n=7) WRBC (n=9)

Allogeneic transfusion rates

Perop Perop+postop Postop

0 100 200 300 400 500 15 20 25 30 35 40 45 50 55 60 65 Bleeding rate (mL/h) Timing (min)

Timing before WRBC availability

CardioPAT® features Reservoir capacity : 2000 mL

Blood volume treated by cycle : 100 mL Cycle duration : 5 min

Volume of WRBC after complete cycle : ≥ 15 mL Postoperative aspiration : - 10 cmH2O to - 40 cmH2O WRBC hematocrit : 62-77%

RBC recovery : 76-92%

Peroperative FFP (U) n(%) - M(IQR) 10 (62) – 4 (4-4) Postoperative FFP (U) n(%) - M(IQR) 7 (44) – 6 (5-8) Peroperative PT (Pool) n(%) - M(IQR) 9 (56) – 1 (1-1) Postoperative PT (Pool) n(%) - M(IQR) 5 (31) – 1 (1-2) Peroperative RBC (U) n(%) - M(IQR) 10 (62) – 4 (2-4) Postoperative RBC (U) n(%) - M(IQR) 7 (44) – 4 (4-6) Hemoglobin h+0 (g/dL) M(IQR) 9 (7.4-10.6) Hemoglobin h+6 (g/dL) M(IQR) 10.5 (8.4-11.9) 0 100 200 300 400 500 0 100 200 300 400 500 600 700 800 900 1000 Washed red blood cells volume (mL)

Volume of collected blood (mL)

Relation between WRBC volume, collected blood

volume and hematocrit of collected blood

40% 30% 20% Tr ans f. ra te s (n = 16)

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